SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 01/01/2016 to 12/31/2016 Medicare Home Health Payment Rates and CBSA Factors FY 2016 Updated 12/02/15.

SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 01/01/2016 to 12/31/2016 Medicare Home Health Payment Rates and CBSA Factors FY 2016 Updated 12/02/15

SUNCOAST SOLUTIONS | THE POWER TO CARE In this tutorial The first section guides you through how to update the Home Health payment rates in Billing and Service Rates Click here to begin section one The second section guides you through how to update your CBSA codes and factors Click here to begin section two The third section will guide you through updating your Non- Routine Supply (NRS) rates and the Outlier FDL ratio Click here to go to section three: NRS and Outlier updates

SUNCOAST SOLUTIONS | THE POWER TO CARE 2016 Rates- Important Notes It is important to know if you are submitting the Quality Data required by Medicare If you do not submit quality data (NQ) then your agency will be reimbursed at a lower rate. This tutorial utilizes the rates for HHA’s that submit Quality Data The final rule published November 5, 2015 can be found using the this URL: https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625-F.htmlhttps://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625-F.html

SUNCOAST SOLUTIONS | THE POWER TO CARE Important notes before you get started You must have the necessary rights to access and update Billing & Service Rates, the CBSA codes and Code Table Maintenance All services that are listed in the first section of this tutorial may not be named the same in your database. Be sure and update all the applicable services that have the bill basis of 15 min units HH More than one HHA Medicare pay source may need to be updated. Also it is recommended that you update the agency rates for each service.

SUNCOAST SOLUTIONS | THE POWER TO CARE 2016 Episode Rates For agencies the DO Submit Quality Data

SUNCOAST SOLUTIONS | THE POWER TO CARE 2016 Per-Visit Rates *

SUNCOAST SOLUTIONS | THE POWER TO CARE How do I add the new Home Health Payment Rates to Solutions? You will add the new rates in Billing and Service Rates. Go to Start  Maintenance Billing and AR oBilling and Service Rates

SUNCOAST SOLUTIONS | THE POWER TO CARE Highlight “Home Health Care”

SUNCOAST SOLUTIONS | THE POWER TO CARE Highlight “Services”

SUNCOAST SOLUTIONS | THE POWER TO CARE Select a “Service” You may have to click on the “+” sign to expand the Services Folder Select the first service: usually “HHA Visit” NOTE: the display may also say “15 Minute Units HH”

SUNCOAST SOLUTIONS | THE POWER TO CARE Updating “HHA Visit” Service You may have to click on the “+” sign next to the “HHA Visit” to see the Agency and HHA Medicare rates It will be important that you update your agency rates as well as your HHA-Medicare rates

SUNCOAST SOLUTIONS | THE POWER TO CARE Agency Rates Updating the agency rates for each service is recommended. This gives you an opportunity to bill a “gross rate” that reflects your agency’s usual and customary charges. The rates entered into the “net rate” reflect the federally published rates for Home Health YOU MUST UPDATE THE AGENCY RATE for the PPS EACH service!!!

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to the “HHA Visit” You may have to click on the “+” sign next to the Agency Rate to see the rates that you have entered previously

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Rate to the HHA Visit Agency Rate Highlight the “Agency Rate” Click on the “New Bill Rate” Button located at the top

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to HHA Visit Change the Effective Date to 01/01/2016 Enter 60.87 into “Net Rate” Make Sure the “Rev Code” is 0571 and the “HCPCS code” is G0156 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Checking for the New Rate After “Saving” in the previous slide, the new rate should be displayed Now you are ready to update the next “Services” item

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “HHA Visit” You may have to click on the “+” sign next to the HHA Medicare pay source to see the rates that you have entered previously NOTE: Your Medicare pay source could have a different name than the one shown here and you could have more than one paysource that needs to be updated

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare 2016 Rate to HHA Visit Change the Effective Date to 01/01/2016 Enter 60.87 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make Sure the “Rev Code” is 0571 and the “HCPCS code” is G0156 Enter in a “Gross Rate” of your choice. Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE 2016 LUPA Add-on’s Calculation The FY 2015 factors are used in calculating the FY 2016 LUPA-Add-on’s RN per visit rate 134.42 x 1.8451= 248.02 PT per visit rate 146.95 x 1.6700= 245.41 ST per visit rate 159.77 x 1.6266= 259.78

SUNCOAST SOLUTIONS | THE POWER TO CARE Three LUPA Add-On’s- if you do not have these contact support

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Rates to the “LUPA-Add-On” The original LUPA-Add-On Each is used for the Skilled Nursing Discipline Click on “LUPA-Add-On” Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to the “LUPA-Add-On ” Change the Effective Date to 01/01/2016 Enter 248.02 into “Net Rate” Enter 78.535 into the “Wage%” Field If the rev code 0551 is entered- please delete this code. The “Rev Code” field should now be blank Do not enter a HCPCS code- if one is entered- delete it Enter 248.02 in “Gross Rate” Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On” Click on “LUPA-Add-On” Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On” Change the Effective Date to 01/01/2016 Enter 248.02 into “Net Rate” NOTE: Make sure that 78.535 is entered into the “Wage%” Field If the “Rev Code” 0551 is entered- please delete this code. The “Rev Code” field should now be blank Do not enter a HCPCS code- if one is entered- delete it Enter 248.02 in “Gross Rate” Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Add the New LUPA-Add-On-PT Click on “LUPA-Add-On- PT” Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to the “LUPA-Add-On-PT ” Change the Effective Date to 01/01/2016 Enter 245.41 into “Net Rate” Enter 78.535 into the “Wage%” Field Do not enter a Revenue or HCPCS code Enter 245.41 “Gross Rate” Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding Paysources If you need to add your Home Health Medicare paysource(s) to the LUPA Add-On’s go to the next slide If you do not need to add any Paysources click on this link to skip to the Adding the New 2016 Medicare Rate to the “LUPA-Add-On-PT”Adding the New 2016 Medicare Rate to the “LUPA-Add-On-PT”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On-PT” Click on “LUPA-Add-On-PT” Click on the “+” to expand the folder if necessary Click on the “New Override Button Select the applicable HHA- Medicare Paysource your agency uses Click OK and the “Enter New Agency Bill Rate” window will open (see next slide)

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On-PT” Click on “LUPA-Add-On-PT” Click on the “+” to expand the folder if necessary Click on the “Medicare pay source” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On-PT” The effective date is 01/01/2016 The “Net Rate” is 245.41 That 78.535 is entered into the “Wage%” Field Do not enter a Revenue or HCPCS code That 245.41 is entered into the “Gross Rate” field Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New LUPA-Add-On-ST Click on “LUPA-Add-On- ST” Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to the “LUPA-Add-On-ST ” Change the Effective Date to 01/01/2016 Enter 259.78 into “Net Rate” Enter 78.535 into the “Wage%” Field Do not enter a Revenue or HCPCS code Enter 259.78 in “Gross Rate” Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding Paysources If you need to add your Home Health Medicare paysource(s) to the LUPA Add-On’s go to the next slide If you do not need to add any Paysources click on this link to skip to the Adding the New 2016 Medicare Rate to the “LUPA-Add-On-ST”Adding the New 2016 Medicare Rate to the “LUPA-Add-On-ST”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On-ST” Click on “LUPA-Add-On-ST” Click on the “+” to expand the folder if necessary Click on the “New Override Button Select the applicable HHA- Medicare Paysource your agency uses Click OK and the “Enter New Agency Bill Rate” window will open (see next slide)

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “LUPA-Add-On-ST” Note: all the information you entered before should populate. Just check that the information is correct. The effective date is 01/01/2016 The “Net Rate” is 259.78 That 78.535 is entered into the “Wage%” Field Do not enter a Revenue or HCPCS code That 259.78 is entered in the “Gross Rate” field Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to the “MSS or MSW Visit” Click on “MSS Visit” (this could also be labeled “MSW Visit” or “SW”) Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Agency Rate to Social Worker Visits Change the Effective Date to 01/01/2016 Enter 215.47 into “Net Rate” Make sure “Rev Code” has 0561 and “HCPCS Code” has G0155 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New 2016 Medicare Rate to the “MSS or MSW Visit” Click on “MSS Visit” (this could also be labeled “MSW Visit” or “SW”) Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to Social Worker Visits Change the Effective Date to 01/01/2016 Enter 215.47 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0561 and “HCPCS Code” has G0155 Enter in a “Gross Rate” of your choice. Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the Agency New Rate to the “OT Maintenance Visit” Click on “OT Maintenance” Visit Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “OT Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure “Rev Code” has 0431 and “HCPCS Code” has G0160 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “OT Maintenance Visit” Click on “OT Maintenance” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “OT Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0431 and “HCPCS Code” has G0160 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “OT Visit” Click on “OT” Visit Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “OT Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure “Rev Code” has 0431 and “HCPCS Code” has G0152 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “OT Visit” Click on “OT” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “OT Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0431 and “HCPCS Code” has G0152 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “OTA Visit” Click on “OTA” Visit Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rate to the “OTA Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure “Rev Code” has 0431 and “HCPCS Code” has G0158 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “OTA Visit” Click on “OTA” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rate to the “OTA Visit” Change the Effective Date to 01/01/2016 Enter 147.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0431 and “HCPCS Code” has G0158 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PPS Each” Click on “PPS Each” Click on the “+” to expand the folder if necessary Click on the “Agency Rate Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PPS Each” Change the Effective Date to 01/01/2016 Enter 2965.12 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0023 and the “HCPCS Code” field is BLANK DO NOT ENTER any dollar amount into the “Gross Rate” field Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PPS Each” Click on “PPS Each” Click on the “+” to expand the folder if necessary Click on the HHA Medicare pay source (if one is listed) Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PPS Each” Change the Effective Date to 01/01/2016 Enter 2965.12 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0023 and the “HCPCS Code” field is BLANK DO NOT ENTER any dollar amount into the “Gross Rate” field Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PT Maintenance Visit” Click on “PT Maintenance Visit” Click on the “+” to expand the folder if necessary Click on the Agency Rate Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PT Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure “Rev Code” has 0421 and “HCPCS Code” has G0159 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PT Maintenance Visit” Click on “PT Maintenance Visit” Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PT Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0421 and “HCPCS Code” has G0159 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “ PT Visit” Click on “PT” Visit Click on the “+” to expand the folder if necessary Click on the HHA “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PT Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure “Rev Code” has 0421 and “HCPCS Code” has G0151 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “ PT Visit” Click on “PT” Visit Click on the “+” to expand the folder if necessary Click on the HHA Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PT Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0421 and “HCPCS Code” has G0151 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “PTA” Visit Click on “PTA” Visit Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “PTA Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure “Rev Code” has 0421 and “HCPCS Code” has G0157 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rate to the “PTA” Visit Click on “PTA” Visit Click on the “+” to expand the folder if necessary Click on the HHA Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “PTA Visit” Change the Effective Date to 01/01/2016 Enter 146.95 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0421 and “HCPCS Code” has G0157 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “RN Education/Training Visit” Click on “RN Education/Training” Visit Click on the “+” to expand the folder if necessary Click on “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “RN Education/Training Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure “Rev Code” has 0551 and “HCPCS Code” has G0164 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Education/Training Visit” Click on “RN Education/Training” Visit Click on the “+” to expand the folder if necessary Click on the HHA Medicare Pay Source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Education/Training Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0551 and “HCPCS Code” has G0164 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “RN Evaluation & Management Visit” Click on “RN Evaluation & Management” Visit Click on the “+” to expand the folder if necessary Click on the “Agency Rate” Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “RN Evaluation & Management Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure “Rev Code” has 0551 and “HCPCS Code” has G0162 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Evaluation & Management Visit” Click on “RN Evaluation & Management” Visit Click on the “+” to expand the folder if necessary Click on the HHA Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Evaluation & Management Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0551 and “HCPCS Code” has G0162 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “RN Observation & Assessment Visit” Click on “RN Observation & Assessment” Visit Click on the “+” to expand the folder if necessary Click on the Agency Rate Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Step 17 (Cont.)-Adding the New Agency Rate to the “RN Observation & Assessment Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure “Rev Code” has 0551 and “HCPCS Code” has G0163 Enter in a “Gross Rate” of your choice. Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Step 17-Adding the New Medicare Rate to the “RN Observation & Assessment Visit” Click on “RN Observation & Assessment” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Step 17 (Cont.)-Adding the New Medicare Rate to the “RN Observation & Assessment Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0551 and “HCPCS Code” has G0163 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE CR9369 RN & LPN Coding Changes The RN G0154 code is replaced with G0299 LPN’s must now be differentiated from RN’s with the code of G0300 The next slides incorporate these changes

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “RN Visit” Click on “RN” Visit Click on the “+” to expand the folder if necessary Click on the Agency pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “RN Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure “Rev Code” has 0551 and “HCPCS Code” has the NEW G0299 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Visit” Click on “RN” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “RN Visit” Change the Effective Date to 01/01/2016 Enter 134.42 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0551 and “HCPCS Code” has the New G0299 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding a new LPN visit Some agencies already have an LPN visit setup Follow this link to the slide to enter the new rates and coding to update the LPN visit if you do: New LPN Visit- Agency RateNew LPN Visit- Agency Rate If not- continue to the next slide for setup instructions

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding a New LPN Visit Type Highlight “Services” under the Home Health Care Program Then click on the “New Bill Service” button

SUNCOAST SOLUTIONS | THE POWER TO CARE New LPN Visit- Agency Rate Enter the Effective Date of 01/01/2016 Select the Basis of 15 minute Units HH Enter 134.42 into “Net Rate” Enter the “Rev Code” of 0551 and “HCPCS Code” of G0300 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Checking for the New Visit After “Saving” in the previous slide, the new LPN visit should be displayed Now you are ready to add the Medicare paysource override to this Visit type

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the Medicare Paysource to the LPN Visit Highlight the LPN Visit Click on the “New Override” button

SUNCOAST SOLUTIONS | THE POWER TO CARE Select the Medicare Paysource Select the Home Health Care Program Select the HHA-Medicare financial class Select the applicable HHA- Medicare Paysource your agency uses Click “OK” and the “Enter New Agency Bill Rate” window will open (see next slide)

SUNCOAST SOLUTIONS | THE POWER TO CARE LPN Visit Medicare Rates Effective Date should be 01/01/2016 Net Rate should be 134.42 Enter 78.535 into the “Wage%” Field “Rev Code” should be 0551 and “HCPCS Code” of G0300 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Checking for the New Rates After “Saving” in the previous slide, the new rate should be displayed Now you are ready to update the next “Services” item

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “ST Maintenance Visit” Click on “ST Maintenance” Visit Click on the “+” to expand the folder if necessary Click on the Agency pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “ST Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 159.71 into “Net Rate” Make sure “Rev Code” has 0441 and “HCPCS Code” has G0161 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “ST Maintenance Visit” Click on “ST Maintenance” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “ST Maintenance Visit” Change the Effective Date to 01/01/2016 Enter 159.71 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0441 and “HCPCS Code” has G0161 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Rates to the “ST Visit” Click on “ST” Visit Click on the “+” to expand the folder if necessary Click on the Agency pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Agency Rate to the “ST Visit” Change the Effective Date to 01/01/2016 Enter 159.71 into “Net Rate” Make sure “Rev Code” has 0441 and “HCPCS Code” has G0153 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “ST Visit” Click on “ST” Visit Click on the “+” to expand the folder if necessary Click on the Medicare pay source Click on the “New Bill Rate” Button

SUNCOAST SOLUTIONS | THE POWER TO CARE Adding the New Medicare Rate to the “ST Visit” Change the Effective Date to 01/01/2016 Enter 159.71 into “Net Rate” Make sure that 78.535 is entered into the “Wage%” Field Make sure “Rev Code” has 0441 and “HCPCS Code” has G0153 Enter in a “Gross Rate” of your choice Click on “SAVE”

SUNCOAST SOLUTIONS | THE POWER TO CARE Checking for the New Rate After “Saving” in the previous slide, the new rate should be displayed

SUNCOAST SOLUTIONS | THE POWER TO CARE One Final Note For any episodes that began BEFORE the new rates changed on 01/01/2016 AND that END on or AFTER 01/01/2016, Suncoast will generate adjusted claims. The claims adjust because Medicare reimburses you based on the rates in effect when you “Final Claim”. You will need to POST the adjusted claims but you do not need to distribute them to Medicare

SUNCOAST SOLUTIONS | THE POWER TO CARE Congratulations! Your up-to-date for another year with your Home Health Medicare Payment Rates Don’t forget to update your CBSA codes in section two of this tutorial Click here to begin section two Click here to repeat section one for entering the new rates Don’t forget to update your NRS rates in section three of this tutorial. Click here to go to section three: NRS payment rates Click here to begin section two- CBSA codes Click here to repeat section one for entering the new rates

SUNCOAST SOLUTIONS | THE POWER TO CARE Core Based Statistical Areas FY 2016 CBSA Codes for Home Health Agencies

SUNCOAST SOLUTIONS | THE POWER TO CARE What is a CBSA? Previously known as MSA (Metropolitan Statistical Area) A five digit code that CMS uses to identify the Urban or Rural county where services are provided CBSA codes are associated with a Wage Index Factor *Important* Check for the current CBSA county code for each county you bill for as it could have changed!

SUNCOAST SOLUTIONS | THE POWER TO CARE Where can I find CBSA’s? You can find your CBSA wage information for FY2016 in the “Downloads” section of the following link: https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625- F.html?DLPage=1&DLEntries=10&DLSort=2&DLSor tDir=descendinghttps://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625- F.html?DLPage=1&DLEntries=10&DLSort=2&DLSor tDir=descending

SUNCOAST SOLUTIONS | THE POWER TO CARE How do I use a CBSA? Each agency is responsible for updating their individual CBSA codes and factors (wage index) in the CBSA Table Maintenance of Solutions Solutions uses the Wage Index (factor) to calculate the reimbursement amount for billing *Important* Check for the current CBSA county code for each county you bill for as it could have changed!

SUNCOAST SOLUTIONS | THE POWER TO CARE How do I update CBSA’s in Solutions? Go to Start  Maintenance  System  County-CBSA Table Maintenance

SUNCOAST SOLUTIONS | THE POWER TO CARE Updating a CBSA Code- (cont.) Select your State Care Program County Then “Search”

SUNCOAST SOLUTIONS | THE POWER TO CARE Updating a CBSA Code (Cont.) Highlight the most current line of the county being updated Click “Copy”

SUNCOAST SOLUTIONS | THE POWER TO CARE Updating a Non-Rural CBSA Code (Cont.) Change the Effective Date to 01/01/2016 Change the Factor Save *See the next slide if the county is “Rural”

SUNCOAST SOLUTIONS | THE POWER TO CARE Updating a Rural CBSA Code Change the Effective Date to 01/01/2016 A rural CBSA County code always begins with 999 then your state number Change the Factor Be sure and enter 3.00 for the Rural add- on percentage Save

SUNCOAST SOLUTIONS | THE POWER TO CARE The “After” Picture for Rural

SUNCOAST SOLUTIONS | THE POWER TO CARE The “After “ Picture Non-Rural

SUNCOAST SOLUTIONS | THE POWER TO CARE Practice Makes Perfect Remember to update each county where service is provided You must also update the NRS rates Click here to go to section three: NRS and Outlier payment rates You must also update the new Home Health Payment rates effective 01/01/2016 in Billing and Service Rates Maintenance. Instructions for this are found in section one of this tutorial. Click here to go to section one-Home Health Payment Rates Click here to restart section two- CBSA Codes

SUNCOAST SOLUTIONS | THE POWER TO CARE FY 2016 Non-Routine Medical Supply (NRS) Payment Rates and Outlier FDL Ratio

SUNCOAST SOLUTIONS | THE POWER TO CARE New 2016 NRS Rates Each year the non-routine medical supply (NRS) rates change also The table in the next slide is from the 2016 final rule: https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625-F.html https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/HomeHealthPPS/Home-Health- Prospective-Payment-System-Regulations-and-Notices- Items/CMS-1625-F.html

SUNCOAST SOLUTIONS | THE POWER TO CARE NRS Table

SUNCOAST SOLUTIONS | THE POWER TO CARE How do I add the new Home Health NRS Rates to Solutions? You will add the new supply rates in Code Table Maintenance Go to Start  Maintenance  System  Code Table Maintenance

SUNCOAST SOLUTIONS | THE POWER TO CARE NRS Rate Update Click on the ‘PPS” code group Click on the “Add New Code” button

SUNCOAST SOLUTIONS | THE POWER TO CARE NRS Adjustments DO NOT change the Code ID or Sort ID (the code or sort ID may be different in your agency database than what is shown here.) In Description enter Supply Adjustment In Effective date enter 01/01/2016 *Use the next slide to enter the User 2, User 3 & User 4 information WITHOUT spaces Save

SUNCOAST SOLUTIONS | THE POWER TO CARE NRS Adjustment for Agencies that DO Submit Quality Data

SUNCOAST SOLUTIONS | THE POWER TO CARE There is no new Outlier FDL Ratio The Outlier Fixed Dollar Loss (FDL) ratio has NOT changed for FY 2016. The finalized FDL ratio is set at 0.45 percent Should you need to add the Outlier FDL- please follow the instructions on the next slide. Otherwise you can skip to the End.End

SUNCOAST SOLUTIONS | THE POWER TO CARE How do I add the new Home Health Outlier FDL ratio to Solutions? To add the new outlier FDL ratio in Code Table Maintenance: Go to Start  Maintenance  System  Code Table Maintenance

SUNCOAST SOLUTIONS | THE POWER TO CARE Outlier FDL Ratio Update Click on the ‘PPS” code group Click on the “Add New Code” button

SUNCOAST SOLUTIONS | THE POWER TO CARE New Outlier FDL Ratio Enter “Outlier” in the Description field Enter 01/01/2013 in the Effective Date field (The FDL has not changed since this date) Enter.45 in the User2 field Enter.80 in the User3 field Save

SUNCOAST SOLUTIONS | THE POWER TO CARE Practice Makes Perfect Click on this link to repeat section 3: Click here to go to section three: NRS and Outlier payment rates You must also update the new Home Health Payment rates effective 01/01/2016 in Billing and Service Rates Maintenance. Instructions for this are found in section one of this tutorial. Click here to go to section one-Home Health Payment Rates Click here to restart section two- CBSA Codes Need Help? - Solutions Annual Tune Up Assistance! Click here to learn more

SUNCOAST SOLUTIONS | THE POWER TO CARE Need Help? Solutions Annual Billing Tune-Up Not sure if you did all the updates needed for the new billing rates? Want to make sure your billing engine is purring? Suncoast Solutions consultants can review your setup for you! Includes a report of issues identified and recommendations for correction Can help you identify missing regulatory elements on your bills which can lead to denials or payment takebacks Helps insure your revenue is not over or understated Contact support@sncoast.com to schedule your tune-up! support@sncoast.com *Consulting Fees Apply

SUNCOAST SOLUTIONS | THE POWER TO CARE About your Solutions Annual Billing Tune-Up Hospice (Effective 10/01/2015) Billing and Service Rates CBSA Codes Bill Map Review Other maintenance areas as needed Home Health (Effective 01/01/2016) Billing and Service Rates CBSA Codes Rural Add-On Supply Adjustments Bill Map Review Other maintenance areas as needed Check- Lists Include

SUNCOAST SOLUTIONS | THE POWER TO CARE www.sncoast.com

SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 01/01/2016 to 12/31/2016 Medicare Home Health Payment Rates and CBSA Factors FY 2016 Updated 12/02/15.

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SUNCOAST SOLUTIONS | THE POWER TO CARE Effective 01/01/2016 to 12/31/2016 Medicare Home Health Payment Rates and CBSA Factors FY 2016 Updated 12/02/15.

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