HQRP: Achieving a Full APU Webinar

HQRP: Achieving a Full APU Webinar


»» Good afternoon, everyone. Thank you for joining us today for the Hospice
Quality Reporting Program or HQRP, Achieving a Full Annual Payment or APU Updates webinar. My name is Sharon Purcell and I will be your
host and moderator today. I have a few housekeeping items to share with
you. This webinar is being recorded. We will provide you with details on accessing
the recording via email when it is available. Closed captioning is available and will appear
at the bottom of your screen. If you would like to download today’s presentation
slide deck, you can download this presentation option and the web links panels in the lower
portion of the screen then click the Browse To button to connect directly to the presentation. If you download the presentation during the
webinar you will open a new browser window and may need to return to the presentation
by navigating back to the browser window hosting the presentation or by clicking the Adobe
icon located in the task bar. Due to a large number of attendees on today’s
webinar we are unable to field question over the phone, but you can submit questions electronically. The phone lines will be on mute for the duration
of the presentation. The audience is in listen-only mode and will
only be able to communicate with us by using the Q&A panel. If you need technical assistance during this
webinar please let us know by entering your question or concern in the Q&A panel to the
right of the presentation. Answers to commonly asked questions have already
been posted to the Q&A panel. You can view questions and responses by using
the scroll bar within the Q&A panel. You may also ask any content-related questions
you may have during this presentation via the Q&A panel. Questions will be assigned to presenters to
address at the end of today’s presentation. We will answer as many questions as possible
during the presentation. Responses to all questions will be posted
to the HQRP Requirements and Best Practices webpage with the next available HQRP quarterly
update. The url is available in the Q&A panel. For more Adobe Connect help, it can be found
by clicking on the “help” icon in the upper right-hand corner of the screen. To join today’s HQRP, Achieving a Full APU,
a Bare Bones Overview webinar, we will cover the following topics. Closed captioning is also available during
this webinar. You will find the captions located in the
panel directly beneath today’s hospice presentation. The slide deck contains a reference list of
acronyms that will be used throughout today’s presentation on slides 5-7. During today’s HQRP, Achieving a Full APU,
a Bare Bones Overview webinar, we will cover the following topics. An overview of the Hospice Quality Reporting
Program or HQRP, the HQRP lifecycle and compliance including the calendar year process, which
includes reporting Hospice Items Set or HIS and Consumer Assessment of Healthcare Providers
and Systems, or CAHPS data, using reports to track your hospice’s data, Certification
and Survey Provider Enhanced Reports or CASPER, knowing the reconsideration process. At the conclusion of today’s presentation,
you should be able to recall basic information about the HQRP, describe the timeframe and
the necessary steps toward HQRP compliance, describe the relationship between quality
reporting and the APU, list the steps for using your HIS and CAHPS data, name at least
two Certification and Survey Provider Enhanced Reports or CASPER to check HIS and CAHPS compliance,
recognize how to use reports to check HIS and CAHPS compliance, define the HQRP reconsideration
process including the timeframe for the steps and steps for submitting a request, locate
resources on the HQRP website. There are a couple of ice breakers in today’s
presentations. During the presentation we will occasionally
engage the audience in polls. The presenter will read the question and possible
answers and the poll will appear in a panel to the lower right of the presentation. If you want to see all answers to the polling
questions and the poll you may have to scroll down. To participate in the poll you simply have
to select your desired responses to the questions. Now let’s try a couple of polls. How many people including you are joining
this webinar together in the same room? A, just me, I am the only one participating. B, two people. C, three or four people. D, five or more people. Please select your responses now as the answers
come in. It looks like we have about 82-83% of people
selecting A, just me. I am the only one participating. Let’s try another. Where in the United States is the very first
hospice that opened in 1974? A, Boston Massachusetts? B, Branford, Connecticut? C, San Francisco, California? D, Washington, D.C.? Please choose your answer. It
looks like we have a lot of people selecting B. Let’s see what the correct answer is. The answer is B, Branford, Connecticut. Now I would like to introduce today’s speakers. Presenting the HQRP, Achieving a Full APU
a Bare Bones Overview are Brenda Karkos, Cindy Massuda and Deborah Dean-Whitaker. Cindy joined the Centers for Medicare and
Medicaid Services, CMS, in 1999 as an IT lead and is responsible for the Inpatient Prospective
Payment Systems IPPS Payment Policy in the Centers for Medicare Management, Division
of Acute Care. Cindy has worked on Medicare demonstrations
with a focus on hospice. She was the project officer in CMS’s Office
of Research Development and Information, now Centers for Medicare & Medicaid Innovation,
CMMI, Rural Hospice Demonstration from 2005-2010. Cindy Massuda brought her subject matter expert
on hospice as lead project officer for the design of the Medicare Care Choices model. She joined the Centers for Medicare Center
for Clinical Standards and Quality in 2015 where she is the Hospice Quality Reporting
Program coordinator. Brenda Karkos is an Associate Nurse Researcher
at Abt Associates. She is an R.N. with many years of clinical
and administrative experience in community health, hospice and oncology. She serves on the Board of Directors for Hospice
and Palliative Care Federation of Massachusetts and is a member of the Hospice and Palliative Care Nurses Association. Before joining Abt, Brenda was the director
of a hospice program in Massachusetts. Her work at Abt is focused on hospice, oncology
and home health projects. Deborah Dean-Whitaker serves as the contracting
officer representative for the Hospice CHAPS Survey and for the In-Center Hemodialysis
Survey. She has been with CMS for five years. Prior to working at CMS she worked as a government
contractor also for 17 years had her own research business. Deborah achieved her Ph.D from Indiana University
in American, State and local public policy. We will conclude today’s webinar with a question
and answer session, and finally a wrap up. We are pleased to have such experienced and
knowledgeable speakers present on today’s webinar. Brenda, Deborah and Cindy, thank you for being
here today. As a reminder before we begin, we encourage
you to submit your questions in the Q&A panel to the right of the presentation. It is now my pleasure to turn the session
over to the presenters. Cindy, the floor is yours. »» Thank you very much. So as an overview for today’s webinar it focuses
on the Annual Payment Update APU timeline cycle. It walks you through the APU cycle. And the cycle begins with reporting of the
data. And the reporting of the data follows the
January-December calendar for each year. That data is used to determine compliance
with the Hospice Quality Reporting Program. Hospices that are fully compliant receive
their full Annual Payment Update. If a hospice is non-compliant with any part
of the Hospice Quality Reporting Program, then those hospices have a 2% reduction in
their Annual Payment Update. So let’s begin with what is the Hospice Quality
Reporting Program, HQRP? The Hospice Quality Reporting Program promotes
the delivery of person-centered, high-quality and safe care by hospices. CMS has adopted measures that were recommended
by multiple stakeholder organizations and developed with the input of providers, payers
and other stakeholders. The HQRP requirements, so currently there
are two requirements for the Hospice Quality Reporting Program, the Hospice Item Set data
collection and submission and the CAHPS Hospice Survey submission. All Medicare-certified hospice providers must
comply with these two reporting requirements for all patients in their hospice. So we like to use this easy visual to remember
what are the Hospice Quality Reporting Program requirements. The Hospice Quality Reporting Program requirements
equals the Hospice Item Set requirements plus the CAHPS Hospice Survey requirements. This means your hospice must meet all requirements
for the Hospice Item Set and for the CAHPS Hospice Survey to meet the Hospice Quality
Reporting Program requirements and receive your full Annual Payment Update. So now let’s look at the submission requirements
for each part of the Hospice Quality Reporting Program. First we start with the Hospice Item Set. So the Hospice Item Set, all Medicare-certified
hospice providers are required to submit the Hospice Item Set admission records and Hospice
Item Set discharge records. The Hospice Item Set data are collected and
submitted on all patient admissions regardless of the payer, the patient’s age, or locations
of receipt of hospice services. The information captured includes items used
in the calculation of 8 National Quality Forum endorsed quality measures. So again, the Annual Payment Update cycle
starts with data collection. The data for this calendar year — this calendar
year which is 2019 began on January 1 and runs through December 31. The Hospice Item Set data needs to be submitted
and accepted within the acceptable threshold. The Hospice Item Set threshold is now 90%,
which means each hospice must have 90% of its HIS data timely submitted and accepted
to meet the HIS portion of the Hospice Quality Reporting Program requirements. This table is added here to show you how data
that you start in the beginning of the calendar year, and we start at this 90% threshold for
that Hospice Item Set beginning in calendar year 2018. So starting in 2018 for every year thereafter,
so this year and 2019 and so on, you have to meet a 90% threshold of your Hospice Item
Set submissions. So data, let’s just start and look at this
chart. So data that you submit in calendar year 2019
from January to December will then be used for the reporting year, the fiscal year 2021. So we go from calendar year to fiscal year. So we start with calendar year 2019 and then
that data is used to impact your Annual Payment Update in fiscal year 2021. And this chart is just showing you that it
follows that same process every year thereafter. So for calendar year 2020 it is your fiscal
year, your Annual Payment Update in your fiscal year 2022, so two years later. I will now turn to the discussion over — I
will now turn to the CAHPS Hospice Survey portion of the Hospice Quality Reporting Program
because it has its requirements that also must be met. So those requirements include that all Medicare-certified
hospices must participate monthly for all 12 months in order to receive their full Annual
Payment Update. They must contract with an approved survey
vendor. The vendor must successfully submit the data
to the CAHPS Data Warehouse. And the data collection year also runs from
January 1 through December 31. So each hospice is submitting HIS and CAHPS
data from January 1 to December 31 to meet the Hospice Quality Reporting Program requirements. With that, I’ll now turn this discussion over
to Brenda Karkos. »» So thank you, Cindy. Now let’s take a look at that HQRP lifecycle
that Cindy’s mentioned. We’ll talk about the role of the hospice and
how and when compliance is determined, and how the process leads to an impact on the
APU. So Cindy mentioned about the submission threshold
for the HIS reporting and submission of the CAHPS data. These activities are on a cycle and the cycle
spans over a two-year period. This graphic shows the cycle. The first section in blue is showing the hospice’s
role in data collection and submission during the one-year period. This is showing January 2018 through the end
of that year until January 1 of 2019. The compliance determination occur at the
beginning of that next year and the payment impact occur on October 1 of 2019 which is
actually the fiscal year 2020. Throughout this cycle there are several time
points to be aware of. So we’ll go into more detail using the graphic
as a guide. Let’s look at the individual components of
this cycle. Let’s start with the data submission as we
begin the cycle. This includes both the HIS and the CAHPS data,
those two components of the Hospice Quality Reporting Program. This is the first part of the cycle and it’s
up to each hospice to meet the required threshold. Your hospice’s submission of both the HIS
and the CAHPS data will determine your APU in fiscal year 2020. The next step in the HQRP lifecycle is the
compliance determinations which are made once CMS reviews the data. CMS will then send out letters of non-compliance
for any hospices who have not met the HQRP requirements. These letters are sent in July to hospices
once the determinations are made by CMS. As we discussed compliance is determined in
the year that follows the data collection year. If hospice providers fail to reach the 90%
threshold for the HIS submissions or if they don’t comply with the CAHPS survey requirements
they will receive notification by CMS. This notification will be in the form of a
HQRP non-compliance letter. CMS sends this letter in two ways, both by
the US Postal Service and via Certification and Survey Provider Enhanced Reports or through
the CASPER system. The CASPER letter will also identify why the
provider is non-compliant. As providers you’ll need to check your CASPER
folder to determine if your hospice has received one of these letters. It is important to be aware as soon as possible
if you’re non-compliant as the letter also alerts the provider how to request a reconsideration. We’ll talk about this next, but in a much
more detail a bit later in the presentation. So let’s look at the reconsideration request. Providers receiving these non-compliance letters
may submit reconsideration requests to CMS and will have 30 days from the date on their
letter in which to do so. It’s important to know about the non-compliance
letters and to be on the lookout for one. If you have any concerns a hospice can request
reconsideration, but the day that CMS sends that non-compliance letter begins that 30-day
reconsideration request period. Since the letters are sent in July this period
will generally fall between July and August. So for example in 2017, the reconsideration
request period began on July 18, 2017 and ended on August 17. Later we’ll get into the entire reconsideration
process in much more detail. If your hospice has applied for a reconsideration
you will be notified about the results by CMS. This notification will fall somewhere between
August and September. Once the reconsiderations are reviewed and
providers are notified the APU will be determined and implemented. The implementation of the APU occurs on October
1 of each year. But remember that it reflects the data collection
period from almost two years prior, January through December of 2018. But let’s talk a bit more about the APU implementation. Compliance with the HQRP impacts your hospice’s
Annual Payment Update or that APU and it is the act of submitting and the acceptance of
the data that determines compliance with HQRP. It is not your actual performance on the quality
measures or on the hospice CAHPS. Failure to comply with the HQRP requirements
will result in a 2-percent point reduction in the APU for hospice providers. And failure to comply also does affect your
results on Hospice Compare. So this last phase will be the receipt of
the APU. So all of these events in this HQRP lifecycle
will occur before the hospices can receive their full Annual Payment Update. Receipt of the full APU is possible for hospice’s
that meet the HQRP requirements. In other words, in order to preserve your
full Annual Payment Update a hospice must fully meet all the requirements that mandate
the collection and submission of HIS-Admission and discharge data for all patients admitted
to their hospice. And they also must participate in the CAHPS
for the 12 months of the year. So now let’s talk a little bit about reporting
for part of the HIS and the CAHPS. I think you should be clear on the HQRP requirements
now. And you know that hospice must meet the requirements
for both HIS and CAHPS and the data must be submitted and accepted on time. So let’s move on to submission. So Cindy mentioned what needs to be submitted
from the HIS to comply with the HQRP. And that is that all Medicare-certified hospice
providers are required to submit HIS-Admission records and the HIS-Discharge records for
all their patients. If you’ve already been doing this for the
last few years you certainly know what that entails. But let’s now talk about when to submit the
data. For the HIS specifically, this data needs
to be submitted and accepted within 30 days after the event date or the target date. A hospice has exactly 30 days to accurately
submit their HIS-Admission data. This is the same for discharge data as well. You may remember that the act of submission
does not equal acceptance. So it’s highly recommend that you submit data
within the first 14 days, ideally 7-14 days to be safe, and to be sure that it is accepted
by the 30-day deadline. If you experience any issues you still have
plenty of time to ensure the acceptance of your data. Unlike the 14-day recommendation, the actual
30-day submission time frames are requirements. These are not recommendations. If you need more detail on what to submit
as well as complete information about the HIS and the requirement, we would recommend
that you preview some of the previous learning events and these can all be found on the CMS
website. We’re going to share some resources for you
and they’ll be on the slide at the end of the presentation. So now let’s talk about where to submit this
data. HIS data is submitted into the CMS Quality
Improvement and Evaluation System or the QIES Assessment Submission and Processing or ASAP. This is referred to as the QIES ASAP system. To submit into the QIES ASAP system, hospice
providers need to take several steps, including obtaining a CMSnet user ID and password, ensuring
that the proper software is installed on the computer you plan to use, obtaining a QIES
user ID and password and ensuring that the HIS records are in the proper electronic format
for submission. One important resource for submitting HIS
data is the Hospice Submission User’s Guide. This guide is available for download and the
links are listed on the slide that you will see at the end of the resource section at
the end of the presentation. You’ll want to make sure that you reference
this guide for any questions you have about the submission process since there are a lot
of great details there. So before your data can be submitted, you
have to make sure that the HIS data is in the proper electronic file format. And that is called xml. It’s important to receive training to ensure
that your submissions are in the correct format and contain the correct information so that
they’ll be accepted into the QIES ASAP system. Some agencies do have their own software for
submission of this part from the electronic medical record. But other hospice providers choose to use
the Hospice Abstraction Reporting Tool or the HART software, which is a free software that’s
available from CMS. So now we know where to submit the data for
HIS records. We would like to talk about how to ensure
that your data was submitted and accepted into the system. Once you submit your records into the QIES
ASAP system, the system will provide an online submission confirmation that the file was
received for processing and editing. The system check, that is, it validates the files
to make sure that they’re complete and in the proper format. It’s important to know that this confirmation
does not mean that your data were actually accepted. So even though HIS records are successfully
submitted it doesn’t mean that they’ve been accepted. The online submission confirmation includes
the name of the file that you submitted and since this confirmation does not mean it was
accepted it’s really suggested that you print this and keep a copy of the confirmation for
your records. Within 24 hours though of successfully being
able to process the file, a system-generated Final Validation Report or the FVR is created
and made available in the CASPER Reporting application. The Final Validation Report, FVR, is used
to verify whether the HIS records were accepted or rejected. The FVR is the only way to verify that submitted
files were also accepted. Hospices will want to access this FVR to verify
whether the records were accepted or rejected and then review to see if there were any errors
noted. It important because records that are rejected
by the ASAP system are not received by CMS and they can not be used in your quality measure
calculations, or for compliance determination. And now I’m going to turn this over to Deborah
Dean-Whitaker who’s going to discuss the CAHPS submission process in more detail. »» Thank you very much, Brenda. The first thing I want to mention to you about
CAHPS is that CAHPS is different from HIS. It has separate procedures, separate requirements
and separate deadlines. So put on your CAHPS hat and let’s talk about
CAHPS. First you’re required to collect CAHPS data
for all 12 months of the calendar year, January 1 – December 31. This is called the data collection year. We are now in the 2019 data collection year
that started on January 1. CAHPS Hospice Survey data is submitted to
the CHAPS Hospice Survey Data Warehouse. Your survey vendor submits your survey data
on your behalf. Data submission deadlines are quarterly. They’re on the second Wednesday of the month
for the months of February, May, August and November. So we will have a February deadline coming
up. We can not accept late data. The act of submitting data is not the same
thing as the successful submission of data. Compliance is measured by the successful submission
of CHAPS Survey data to the CAHPS Survey Data Warehouse. It is critically important that your vendor
successfully submit your data and do it on time. If your vendor does not successfully submit
data to the data warehouse you will be out of compliance and your Annual Payment Update
will be subject to a 2% reduction. It is therefore a very good idea for you to gain
access to the data warehouse and review reports about your data submission. And it is also important to stay in touch
with your vendor. Here are some things you can do to increase
the probability that the data you submit are accepted and that you are successful in submitting
data. First you must contract with the CMS-approved
vendor. This is a requirement. There is a list of vendors on this survey
data website. And the url for that will be shown in a slide
coming up and I’ll call it to your attention. There are quite a few vendors on this list. We suggest you call a few of them and see
what you think. Also you must authorize your vendor. Your vendor can not submit data unless they’re
authorized to do so. This has been a place of trouble sometimes
for hospices because they forgot to authorize the vendor and the vendor is banging on the
door to get into the data warehouse and can’t. You can not submit data without authorization. We also suggest you communicate with your
vendor and monitor data submission. Make sure your data is successfully submitted
before the deadline. Make sure you know how to get reports from
the data warehouse. You must go to the survey website. Again I’ll show you the url. Choose the Information for Hospices tab on
the left-hand menu and that page will have instructions on how to get reports. It will also have instructions about how to
authorize your vendor. Now I have a tip and it’s very important. Contact us if you want to change your vendor. We’re not going to tell you you can’t do it. But remember, you have to have data being
collected every month of the year. Now suddenly you’re changing your vendor. So are you collecting data while you’re changing
the vendor? It’s a high-wire act. And if you misstep you can fall out of compliance. We can help you prevent that. Contact us if you want to change your vendors. Our contact information is also on the website. Please contact us. We’re happy to walk you through it. We’re happy to handhold you through it so
you don’t have a problem. Another thing I would suggest is, we recommend
you keep this in mind, when you buy a hospice, if you work for a hospice company and they’re
buying a hospice, you’re buying their CAHPS data. If the hospice you buy is compliant with CHAPS,
you might think about whether or not you want to keep their current vendor or change vendors. And if you’re going to change it, you want
to let us know. You may also want to consider their CAHPS
status in terms of if they are compliant or not? Because word to the wise, I would suggest
that you keep this in mind. Now I want to talk to you about CAHPS Hospice
Survey exemptions. Both of these exemptions are unique to the
CAHPS Hospice Survey… … So I’m going to go ahead as if it did not
happen and if there’s a problem, please let me know orally. There are two CAHPS Hospice Survey exemptions,
one is size and one is for newness. I’m going to start by talking about the size
exemption. I now have a size exemption up, number 46. If your hospice serves fewer than 50 survey-eligible
patient/caregiver pairs in the reference year, you are eligible to apply for the size exemption. To apply for the size exemption go to the
survey website. There it is ladies and gentlemen, www.HospiceCAHPSsurvey.org. Hi. This is Charles Padgett. I’m just going to finish up with Deborah Dean-Whitaker
here. We’re having some phone problems. So she was going to go over the CAHPS size
exemption. I’m just going to go over that again. As she stated, if your hospice served fewer
than 50 survey-eligible patients/caregivers in the reference year you’re eligible to apply
for a size exemption. In order to do so you can go to the survey
website which is www.HospiceCAHPSsurvey.org. Then look at the Participation Exemption for
Size. Then you’ll fill out the form that’s available. You can submit that form online. To fill out the form you count patients in
the reference year. The reference year equals the previous year. So the current data collection year is 2019
that we’re in now for example. So the reference year is going to be 2018. The exemption is only good for one year. You need to resubmit a request annually for
the exemption. And the deadline for requesting the size exemption
is December 31 of 2019. And that’s the 2019 data collection year. After you submit the form you’re going to
receive an acknowledgment email. That does not mean that you’re approved, that’s
important to know. We check your accounts before the APU season
and then decide. Save the acknowledgment email for future reference
so that you have it. And then for the second exemption which is
the newness exemption, if you receive a new CCN on or after the start of the data collection
year, then you are automatically exempted for one year. CMS grants that exception. Once again, we recommend that you save your
letter with the new CNN and save the envelope. So now there is a polling question. And this is asking where do you submit your
HIS data for the Hospice Quality Reporting Program? Your options are A, the Hospice Survey Data
Warehouse? B, the RAND corporation? C, the quality manager at your hospice? Or D, the QIES ASAP system? And it looks like the majority of folks got
it right. It looks like we have about almost 98% that
answered D, the QIES-ASAP system. »» Okay. Thank you. Charles. I can take it for the next question. »» Sure. »» Okay. So our next question is, who submits CAHPS
data for the HQRP? Is it the Hospice Survey Data Warehouse? The RAND corporation? The quality manager at your hospice? Or your survey vendor submits your data on
your behalf? It looks like we have quite a few answers
coming in. And the answer is D, your survey vendor submits
your data on your behalf. So thank you. We’re going to get moving on to the CASPER
Reports themselves. So today we’ll give you a brief overview of
the reports that you can find on the CASPER Reporting application with some simple explanations
about how to use them. And we’re not going to provide a lot of detail
today. But there’s much more information on some
of the trainings that we’ve done previously. And you can find these on the CMS website
and some of those resources will be listed at the end of the presentation. So there are many valuable hospice-specific
reports available in CASPER. The CASPER Reporting link is available to
providers on the Welcome to the CMS QIES System for Providers webpage. You can obtain more information about the
reports highlighted in the presentation in the CASPER Reporting User’s Guide. And this user’s guide is available on the
CMS QIES Systems Provider webpage and also on the QIES Technical Support Office or QTSO
website. Now let’s get into the reports that you’ll
find in CASPER. The first thing to know is that there are
two report categories. One is called the Hospice Provider Report
category and the other is the Hospice Quality Reporting Program category. And you can see the Hospice Provider Report
category is circled in red here. There are four types of error reports. These are the HIS Record Errors by Field by
Provider, the HIS Records with Error Number XXXXX, the HIS Record Error Detail by Provider,
and the Hospice Error Number Summary by Provider by Vendor. So I’ll give you a brief explanation of each
of these. So the HIS Record Errors by Field by Provider,
this report shows by error the number of HIS records where the particular error was encountered
and the percent of HIS records that the error — that had that error during the specific
timeframe. The HIS Records with Error Number XXXXX is
a user-requested, on-demand report. So this one assists you in researching the
cause of any late submissions by running for errors such as number 3034a or 3034b. So here’s a sample of the HIS Record Errors
by Field by Provider Report. And you can see that the first error by number
in this first column is 3034a. This message tells us that the record was
submitted late. Once you have this information you can actually
run the other report we talked about, the Error Number XXXXX number. You can get a list of the patients and the
dates where this error was encountered. Then you might research what could have happened
and how to prevent this error from happening in the future. So let’s look at these two other error reports. These are the HIS Record Error Detail by Provider,
and the Hospice Error Number Summary by Provider by Vendor. So the first one tells us some details about
the HIS ID, the errors encountered in the Hospice Item Set records that were submitted
during a specific period. The report can help us address recurring errors
and can also be used in quality assurance QA programs if you have repeated errors. The second report is summarizing the errors
submitted by or on behalf of the provider during the specified period. So it helps to determine and report vendor-specific
issues such recurring FATAL errors. You can use these two error reports to gain
more detail regarding the errors that were encountered during the HIS Submission. So this screenshot just shows you the report
categories options for the HIS record error by detail report. And the CASPER report submit pages for the
other hospice reports may look very similar. And you can refer to Chapter 3 in the Reporting
User’s Guide for some specific information about each of these reports. To request this report you just choose the
date range on this dropdown menu. The HIS record error detail by provider report
can identify which errors occurred during that particular date range. So now let’s move away from the error reports
and look at the Hospice Admissions report. This report is for details regarding patients
who are admitted within a specific period. This lists only patients with an accepted HIS-Admission
submitted with an admission date within the specified period that you choose. In this report the date range requested was
October 1 to October 4. So the information in this will give us any
patients that were admitted and accepted during that timeframe. And you can see on this one it’s very similar
to the admission report but this is the discharge report. And it lists only patients with an accepted
discharge submitted within the discharge date in that specific period. And this one is from October 1, 2016 to September
30, 2017. And this can be used to verify the HIS-Discharge
records submitted and accepted by the ASAP system for each hospice patient during that
specific time period. So here’s a really important report. And this is the Final Validation Report we
spoke about earlier, or the FVR. We know that it’s critical for hospices to
ensure that submitted records have been accepted. If a record gets rejected the hospice must
correct the errors that caused the record to be rejected and resubmit to the ASAP system. That’s why it’s important to submit your records
really early before that 30-day deadline. So the FVR will indicate whether the records
submitted in each file were accepted or rejected, and it will give you details if there are
any FATAL errors or warning messages that were encountered. This report is autogenerated and the ASAP
system-generated FVR is automatically purged from the system after 60 days. Although it can be user-generated upon request
if you fail to make a copy of it when you had it available to you. Here’s a screenshot of the Hospice Final Validation
Report. The top part of the report contains the details
of the file such as the date, the time the file was submitted, the user ID that submitted
the file and some hospice-specific information and it includes a summary of the submission
statistics for the HIS records contained in the ZIP file such as the number of records
processed, the number accepted and the number rejected. And beneath this is some information about
each HIS record processed by the ASAP system including the record and patient-specific
information. So you want to check to make sure the information
on here is correct and the record was accepted. Now let’s talk about the Hospice Submitter
Final Validation Report. So the Final Validation Report is automatically
generated but that’s only for HIS Submission files for which the provider of the file can
be identified. In contrast, this report, the Hospice Submitter
Final Validation Report must be manually requested. The contents of this report are very similar
to the system-generated report, but the submitter report will display error details for records
that could not be processed by the system because the provider associated to the file
couldn’t be identified. So this report provides detailed information
about the status of selected submission files. It indicates whether the records were accepted
or rejected, it details warning messages and FATAL errors, but it can only be requested
by the user who submitted the original file. So examples of when you might use this would
be if for some reason the system-generated, FVR is not available in the folder after 24
hours. The total record count on the list of submissions
in the hospice file submission is displaying a 0. This indicates that there’s a severe error. That’s when you might use this report to find
out what the error was. So this next report is the Hospice Item Set
Print report. It can be requested only for HIS records that
were accepted into ASAP. This report lists the item number and item
responses submitted for each HIS record. So this one allows for easy viewing of the
values that were submitted for the HIS Item in the individual record. This report can be useful if the hospice had
some questions about why a patient did or did not trigger the hospice quality measure. This next one is the Hospice Item Set Submission
Statistics by Provider Report. This one summarizes the submissions made during
a specified period and the statistics for each submission. It allows electronic compilation of information
that would otherwise have to be manually retrieved from the individual FVRs. In this sample report you can see that the
report displays a submission date, the time, the Submission ID and the following information. It has the number of records successfully
processed from the file by the ASAP system. It has the number of records rejected or not
saved into the system because of some FATAL errors, and it has the number of records that
passed the ASAP system validation and were save into the national database. And the percent of records from the submission
file that were rejected, you can see on this screenshot that something was wrong on September
22 as 10 of the records processed, all of them, 100% of them were rejected however. So here’s one called the Hospice Item Set
Submitted Report. And it lists the accepted HIS records and
inactivation requests submitted by or on behalf of a provider during the specified period. In the sample report here it displays patient
identifying information such as the ID, the patient name, social security or Medicare
number, and also displays the HIS reason for assessment value. So that is whether it’s an admission record
or discharge record. It has the date the record was submit into
the ASAP system and identifies the record type, whether it was a new record or a modified
record. Okay, now this is the Hospice Roster report. This is also a very good reference for you. It helps you to verify that all your current
patients have had their appropriate HIS-Admission record accepted and that all discharge patients
no longer display to verify that the discharge records have been submitted. It can be used as a good quality assurance
tool. All the patients on this report are considered
active patients as of the day the report is run. This report is one way to do a quick check
to make sure there aren’t any discharge patients who have not had their discharge records submitted
or any active patients for which you have not yet submitted an admission record because
their names will not appear on the report. So this is the last one on this list. And it is one of the most important reports
for checking compliance for HQRP. And this is the Hospice Timeliness Compliance
Threshold Report. You can see it highlighted here on the list. The Hospice Timeliness Compliance Threshold
Report is a user-requested, on-demand report in CASPER. And we’ll go through this in a bit more detail. For this user-generated report, the fiscal
year is the only submit criteria. So you just have to choose what year you want
to look at. This report summarizes for the selected fiscal
year the number and the percent of HIS records submitted within the 30-day submission deadline. So it has the number of HIS records submitted,
the number submitted on time, the percentage of HIS records submitted and it also has the
identifiers such as the CCN or the facility ID. So this Timeliness Compliance Threshold Report
provides the percentage of HIS records submitted within that 30-day submission deadline per
fiscal year. The bottom of the report also identifies the
required percentage for the year, which would be 90% at this point. So here’s a sample of what it looks like. This is a good way to keep track of how you’re
doing in terms of your compliance with the HQRP. This one shows the number of HIS records with
67. And the number of records that were submitted
on time were 46. So the percent of records submitted on time
were 69%. So they have a little work to do to get to
make sure they meet the required threshold. So now we’re going to move away from the provider
reports to a different category and these are the Hospice Quality Reporting Program
report categories. And to access this category you go to the
Reports tab and then you select the Hospice Quality Reporting Program which is on the
left, encircled in red. So these reports are user-generated, on-demand
reports in CASPER. The first one, the Hospice-Level Quality Measure
Report shows the CMS measure ID, the numerator and the denominator for each measure and it
also shows the hospice’s observed percent, the comparison group national average for
the same time period and the comparison group national percentile. And the second report, the Hospice Patient
Stay-Quality Measure Report identifies each patient whose qualifying HIS record was included
in the quality measure calculation for the selected period. So here’s an example of the Hospice-Level
Quality Measure report. For each of the 8 measures the report shows
the CMS measure ID, the numerator and the denominator. And you can see the hospice’s observed percent
which is 100% in some categories, the comparison group national average for that same time
period and the comparison group percentile. The comparison national percentile indicates
the hospice’s rank nationally. For example the pain screening measure percentile
of 29 on the report indicates that 29% of the hospices in the nation had a quality measure
score that was less than or equal to this particular hospice. So in other words, they performed the same
or worse than this hospice. So this hospice again has some work to do
on pain screening to get higher up in their percentile. So here’s an example of the Hospice Patient
Stay-Level Quality Measure Report. And this report provides a breakdown of the
hospice level report for the same time period. And this report indicates the measure status
per measure per patient. So I’ll describe a little bit of the values
that you’re seeing. A “B” displays when the measure was not triggered. And the B is in bold. An “E” displays when the measure was excluded. There was an “X” displayed, that shows that
the measure was actually triggered. And this means it passed the measure. And you can see a “C” in this document because
the admission record was missing. A “C” is displayed if the admission date column
next to the date to indicate that the admission date was extracted from the discharge date. Something happened with the admission record. It can’t find it. For example, the Hospice Comprehensive Assessment
Measure is reported for stays with admission dates greater than or equal to April 1, 2017. And for stays with admission dates prior to
that the result of the measure would be showing a “D”. So these last few are called the Hospice Provider
Preview Reports. And they can be found in CASPER. And these are two separate reports that are
automatically stored in your provider’s shared folder in CASPER. This is not the same VR as the Final Validation
Report. The purpose of these reports is to give providers
the opportunity to preview the HIS quality measure results and Hospice CHAPS Survey results
prior to public display on Hospice Compare. These two separate reports are located in
your CASPER folder, the Hospice Provider Preview Report and the CAHPS Hospice Survey Provider
Preview Report. And hospice providers are encouraged to use
these reports to review their HIS quality measure results and their facility-level CAHPS
Survey results. So prior to each quarterly release of data
on Hospice Compare the hospice providers are given an opportunity to review their results
during the 30-day preview period. These reports are provided after the freeze
date, after which providers can not make changes to their HIS records. Because of this hospices are not able the
make changes to the underlying data. So providers need to take action to ensure
all the data is accurate before the freeze date. And if hospices fail to make necessary corrections
to their HIS data before this specific freeze date, CMS will base the measure on the data
that they have at that time. So should a provider believe a denominator
or something in that quality metric is in error, they can request a CMS review. These reports are available for a period of
60 days from the report release date. Hospices are encouraged to download and save
these reports for future reference. So here’s an example of the Provider Preview
Report. And you can see the hospice identifying information
at the top and beneath the measure, the results. And here’s a sample of the CAHPS Hospice Provider
Preview Report. This report will show you each measure category
in your hospice’s percent for the bottom, the middle and the top responses. And it also shows you the national percentages
for each of those. You can compare yourself to others in the
country. So let’s just review by asking a few questions
of the audience. So here’s our first question regarding the
material that was just presented about the reports. Which report provides detailed information
about the status of select submission files? Is it A, Hospice Item Set submission statistics
by provider? B, Hospice Final Validation Report? C, the Hospice Item Set submitted? Or D, HIS record error detail by provider? A lot of people are chiming in here. It looks like most people are choosing the
Hospice Final Validation Report. And that’s correct. The answer is B, the FVR that provides the
detailed information about the status of select submission files. Remember this is the one this is autogenerated
for each and every submission. And it’s placed in your Providers Validation Report
folder. Okay, so now for one more question regarding
reports. Which report provides the percent of HIS records
submitted and accepted within the 30-day submission deadline per fiscal year? Is it the Hospice Item Set submission statistics
by provider? The HIS records with Error Number XXXXX report? The Hospice Timeliness Compliance Threshold
Report? Or D, Hospice-Level Quality Measure Report? It looks like most people are choosing. That is the correct answer. So C is the correct answer. It’s the Hospice Timeliness Compliance Threshold
Report. Okay, so we’re going to go into this reconsideration
process next and talk more about details about that process. So let’s just take a look at the graphic again. Once CMS makes that initial determination
at the beginning of the year they will notify hospices who did not meet the compliance threshold. And this will be that letter of non-compliance
that we spoke about earlier. And once the letter arrives the hospice will
have exactly 30 days from the date on the letter to request a reconsideration if they
don’t agree with the notice. So what exactly is reconsideration? Well, reconsideration is a request for a review
of the non-compliance decision prior to the 2-percentage point reduction in the hospice’s
APU that will take effect on October 1, so the beginning of the next fiscal year. So non-compliant providers will be notified
of the decision through this letter we spoke about by US mail or through the CASPER system. We talked about the APU and then any hospice
determined to be non-compliant will be subject to a reduction by 2-percentage points. And this can occur if they’re non-compliant
with either HIS or CAHPS or both the HIS and the CAHPS. So if you believe your hospice has been identified
for this payment reduction in error, you do have a right to request this reconsideration. And we have listed the website here, but there’s
more information at the end of the presentation on those resource slides as well. So hospices can file for reconsideration if
they received a letter and if they believe that they’ve received the letter in error. And they have 30 days from the time they receive,
or the date on that letter to actually submit a request for reconsideration. Failure to submit it in a timely manner means
that you will be subject to the 2-percentage point reduction. Let’s review the process for this. First CMS will notify the hospices that they’re
non-compliant. And then hospices should look for that letter
and be sure to access their CASPER system since either letter serves as notice for the
non-compliance. And hospices that have received the letter
can certainly request a reconsideration if they feel it’s in error. Let’s walk through what you need to do to
submit this reconsideration request. The only method to use for this submission
is email. Late requests and those submitted by any other
means will not be reviewed. The request must be sent to the following
email address. Again it’s listed here as well as at the end
of the presentation. So the subject line should read “hospice ACA
3004 reconsideration request” and include the hospice’s CMS certification or CCN number. And the email must include the following information,
the CCN number, the business name and address, the name of the CEO or designated representative,
and the identified reason for non–compliance that CMS put in the letter. You’ll also include any information you have
to support your belief that this was in error. So you really need to include all the evidence
you have about why you should not be found in error. So this request for reconsideration must be
accompanied by any supporting documentation demonstrating compliance. CMS won’t be able to review a request without
the necessary documentation. So just some examples of documentation you
could include might be some email communication, or for HIS reporting you might include some
of the Final Validation Report information from the CASPER system. Or for CAHPS you might have evidence that
your hospice served fewer than 50 survey-eligible decedents, or that there was continuous data
collection throughout the 12 months. So since email is not secure you have to be
really careful you don’t include any PHI or PII, or any HIPPA violations as this will
send a security alert to CMS when your information is sent over. So CMS should acknowledge receipt of the reconsideration
request within 5 business days through an email. Following its review of the request and supporting
documentation, they will issue a decision and this will come through regular mail through
the MACs or an electronic letter through the CASPER system. If the decision upholds the finding of non-compliance,
the provider may file an appeal with the Provider Reimbursement Review Board. Let’s just review this whole timeline for
reconsideration once more. In July, non-compliant hospices that failed
to meet the hospice quality reporting requirements are notified. CMS will prepare letters for CASPER and
also send the letters to the MACs. These will be sent over by US mail to
the hospices. During July and early August the reconsideration
requests are due. These will be due to CMS exactly 30 days from
the date on that letter. And then late August through September CMS
will notify hospices of the decision on the reconsideration request. On October 1 any hospice determined to be
non-compliant will be subject to the 2-percent reduction in their APU for that fiscal year. So that wraps up our discussion on reconsideration. We just have a few more Knowledge Checks to
go through. So which of the following statements is not
true with regard to reconsideration? Is it A, a hospice has 30 days to submit a
request? B, CMS will contact the hospice if they have
further questions? C, requests can be sent only by email? Or D, CMS will issue its decision by regular
mail and through the CASPER system? So it looks like the answer is B. CMS will
contact the hospice if they have further questions. Okay. So I’m just going to quickly run through the
resource slides then we’ll have some Q&A. So these last few pages just have resources
that you can follow these links to find more information. On this page you’ll find resources for the
HQRP Reporting Program on the CMS website for the CAHPS Survey information. Links here will give you resources on the
Provider Preview Reports and the reconsideration request webpage which has lots of information
we just went over. And here are some other resources on the QIES
Technical Support Office or QTSO website, as well as how to obtain the Hospice Submission
User’s Guide and CASPER Reporting User’s Guide. And if you want to see some previous trainings
which again have much more detail about these reports you can go to the Training Library. There’s lots of great information in there
on previous trainings that we’ve done, as well as you can look at requesting reports
via CASPER. You can find more information there on how
to request reports. And then this is just some information about
the different quality help desks, the Hospice CHAPS Survey help desk and the CHAPS Hospice
Survey Data Warehouse, the QIES help desk and APU reconsiderations help desk. Now I’m going to turn it over the Sharon,
I think. »» For the Question and Answer session,
we’re going to be doing questions on the different topics throughout the presentation. So this is Cindy Massuda. I’m going to start with the first question. So can you tell me how I get started with
the Hospice Quality Reporting Program? Well as we discussed in the first section
of this presentation today, to be compliant with the Hospice Quality Reporting Program
overall hospice providers must comply with the individual requirements of both the Hospice
Item Set and the CAHPS Hospice Survey. And these requirements do differ. There’s a Documents and a Downloads section
of the Hospice Quality Reporting webpage called “getting started.” I would suggest you go to the CMS website
under the Hospice Quality Reporting Program and bookmark that page. Once on that page scroll all the way down
to the Downloads section and you will see a document dated September 2017. This getting started pdf will help guide you
on getting started with the process. In order to provide time since this webinar
goes to 3:30, I’m going to turn to my colleague Deborah Dean-Whitaker with questions related
to CAHPS. »» Thank you very much. And I want to thank Charles for stepping in. I don’t know what happened and I’m sorry about
that. Here’s my first question. I have looked at the CAHPS Hospice Preview
Report for our hospice, it doesn’t seem right to me. Is it possible to request a review of our
CAHPS Preview Report data? The answer is yes, you can. On the CAHPS Preview Report there’s an orange
box that provides instructions for what to do if you would like to get your data reviewed. It connects you really with the technical
support team. So please look at your report. Look at the orange box and you will see what
to do. We’ve had another question. I’ve had some problems with our survey vendor
and we missed a few months sending out the CAHPS data last year. Will this impact our APU? The answer is probably yes, unless you are
exempt for size or newness. To comply you need to have participated monthly
for all 12 months. There are disaster exemptions that do exist. So you may want to look into that as well
if you were subject to a disaster. And now I believe I will turn this over for
questions over to my colleague Brenda. »» Sure. Hi there. I have a question here that says, it’s about
the CASPER Reports. When speaking about the reports you mentioned
that there are warning messages and FATAL errors. Can you talk more about the differences between
these two? I’m going to turn this over to Charles for
the answer. »» Sure. Thank you. So the warning messages alert you to inconsistencies
or issues that you should be aware of or you may want to address. But with a warning, the issue is not severe
enough to actually reject the record. Records with only warning messages are still
accepted into the database. So examples of warnings can include late submission
warnings, inconsistent responses or dates. In contrast however, the HIS records that
receive FATAL errors are not accepted into the ASAP system. So you will definitely want to monitor your
Final Validation Reports or the FVRs for these errors so you can address, and resubmit any
of the rejected records to be sure that your HIS records are accepted into the national
database. More information about the error messages
and warnings are detailed in the HIS Data Submission Specifications that are available
on the HIS Technical Information Page on the CMS website. »» Okay. Thanks Charles. I have another one for you actually. How often would you recommend that we run
the Timeliness Compliance Threshold Report? »» Sure. It’s really up to each hospice to decide how
often it wants to run these reports. However, monthly may be a good routine. Running the Hospice Timeliness Compliance
Threshold Report monthly would help you to determine if you’re having issues maintaining
compliance with the 30-day submission requirement and it would still give you enough time to
correct the issues before it’s too late to do anything about it. »» Thank you. »» Cindy, I’ll turn it back to you. Do you have a few more questions? »» Sure, I do. I have more than a comment. So our hospice has not received a letter of
non-compliance, does that mean we are compliant with the Hospice Quality Reporting Program? That’s a really good question. So we discussed the compliance is determined
in the year that follows the data collection year. If a hospice provider’s failed to reach the
90% threshold for the Hospice Item Set submissions or do not comply with the CAHPS Hospice Survey
requirements they will receive notification from CMS. This notification will be in the form of a
Hospice Quality Reporting Program non-compliance letter. CMS sends this letter in two ways, both by
the United States Postal Service, USPS and also via the Certification and Survey Provider
Enhanced Reports which is our CASPER system. Hospices should be looking for the letter
in the CASPER system. Compliant hospices will not receive a letter. You should also double check your provider
reports for the details about your compliance percentage because as you know, you can identify
yourself, your level of compliance throughout the year. Another question that came in is what percent
of Hospice Item Set submissions are required this year to avoid the Annual Payment Update
reduction? So the threshold for the Hospice Item Set
record in calendar year 2019 is 90%. This threshold will remain the same for each
year from now on. This single threshold applies to all of the
HIS records. So at least 90% of the HIS records need to
be submitted on time, which is within the 30-day deadline to meet the threshold. There are no separate thresholds for admission
and discharge records. And with that, I’m going to turn it over to
my colleague Deborah for any additional questions related to CAHPS. »» We have another CAHPS question here. Does my hospice have to get a specific number
of responses to comply with the CAHPS Hospice Survey requirements? The answer is, no. You do not need a specific number of responses
to be considered compliant for the Annual Payment Update. However, in order for your data to be published
on Hospice Compare you must have at least 30 complete surveys over the last 8 quarters. And now I’m going to turn it back over to
Brenda. »» Hi there. I have another one here from CASPER. What if my threshold report seems off? For instance if there’s a discrepancy in the
percent submitted on time and I feel that it should be higher? What should I do? So if you feel there’s a discrepancy with
the percentage of HIS records submitted on time in your Hospice Timeliness Compliance
Threshold Report you can verify your numbers by running the HIS records with Error Number
XXXXX report. And you’ll be looking for errors that are
3034a or 3034b for that same period to determine which of those HIS records was submitted late. So the number of records that encountered
one of those errors should equal the difference between the number submitted and the numbers
submitted on time on your threshold report. So for example, if your threshold report indicates
that you submitted 100 HIS records in total and submitted 75 on time, then you should
see 25 HIS records that received an error number during that same period. And that would make up for your 100. You’ll know there’s some issues there and
some discrepancies in what you’re sending in. And I would recommend that you contact the
QTSO help desk if you have any questions. And there’s a question here that we could
have Charles answer about Hospice Compare. So how does all this relate to Hospice Compare? We heard a lot about HQRP. But can you explain how it relates to Hospice
Compare? »» Sure. I’m happy to answer that. So Hospice Compare is actually the vehicle
by which CMS publicly displays hospice quality data. And the goal of Hospice Compare is to help
consumers compare hospice providers on their performance and assist them in making decisions
that are right for them, healthcare decisions. When appropriate providers can inform their
patients and family members about the new Hospice Compare website and explain that the
Hospice Compare website provides a snapshot of quality of care a hospice offers. And they can encourage patients and their
family members to review quality ratings and use this to help patients and family members
make the best decision for their care. More information on Hospice Compare can be
found at the actual Hospice Compare Website and that is www.Medicare.gov/hospicecompare/. »» We have other questions? »» I have a few more questions that have
come in related to the Hospice Item Set. This is Cindy Massuda. So a question that came in is, what is the
penalty for not submitting the Hospice Item Set admission and discharge in the required
time allowed? And related to it they said, does Medicare
deny the claim for untimely submission or does Medicare penalize the agency or not pay
the claim all together? Let’s just clarify all of this. The Hospice Item Set and the Hospice Quality
Reporting Program in general, it is completely unrelated to claim submissions and payment. So the purpose of the Hospice Quality Reporting
Program is pay for reporting and it is not tied directly to your payment of claims. The distinction is that compliance with the
requirements the Hospice Quality Reporting Program, meeting the requirements will affect
your Annual Payment Update and you can be subject to up to a 2-percentage point reduction
in your Annual Payment Update if you don’t comply with the Hospice Quality Reporting
Program. So the Hospice Item Set is a requirement of
the Hospice Quality Reporting Program along with the CAHPS hospice survey. The penalty for failing to meet the Hospice
Quality Reporting Program requirement is a 2-percentage point reduction in your Annual
Payment Update for the reporting fiscal year in question. So we’re currently in calendar year 2019. The associated reporting year is fiscal year
2021 APU reporting year. So if you fail to meet the Hospice Item Set
or the Hospice CAHPS requirement for this year, your Annual Payment Update will be reduced
by 2-percentage points for fiscal year 2021. This payment penalty lasts the duration of
the fiscal year involved, so it lasts for the entire fiscal year of 2021. You can find more information on the timeliness
compliance threshold on the CMS website, the HQRP webpage. There’s a download called the “Timeliness
Compliance Threshold Factsheet Update” which was in August 2016 that you can find helpful. Another question that came in has to do with
the new hospice and I’m trying to understand the process. Our hospice has had some problems with late
submissions. Can you clarify again how late submissions
of the Hospice Item Set records impact my Annual Payment Update? That’s a very good question. Well we’ve discussed that all medicare-certified
hospice providers are required to submit Hospice Item Set admission and Hospice Item Set discharge
records. Hospice Item Set data are collected and submitted
for all patient admissions. This data needs to be submitted and accepted
in the system within the 30-day deadline in order to ensure compliance with the Hospice
Quality Reporting Program and prevent any reduction in your Annual Payment Update. Compliance thresholds have been incrementally
increasing since 2016 and are now set at 90%. So for your hospice to receive the full payment
update in fiscal year 2020 the threshold has to be met with your calendar year 2018 data. So your calendar year 2018 data had to have
a 90% threshold of submitting HIS data. And then, the single threshold applies to
all of the HIS records. As long as 90% of the HIS reports are submitted
on time within the 30-day deadline your hospice will meet the threshold. It’s important to submit all your data even
if it is late because the data is also reported on Hospice Compare. And with that, I will turn it over to Deborah
Dean-Whitaker if there’s any additional questions related to CAHPS. »» We do not have additional questions for
CAHPS. May I turn it back to Brenda? »» Sure. I have a question here regarding the difference
between the reconsideration process versus exemptions and extensions. So they say, I’m trying to understand the
difference between these two. Can you clarify the difference? So let’s start with the exemptions and extensions. So Deborah mentioned in the CAHPS presentation
that there are exemptions for size and newness. But this is different, that is not for HIS. So let’s talk in general. CMS does recognize that there are times when
extraordinary or extenuating circumstances can delay or prevent the submission of the
required data. For those instances an exemption or extension
might be granted by CMS, such as some natural disaster or man-made disaster that prevents
timely submission. Or it could be a disaster that affects a lot
of providers in a wide area or just may be a single provider. So these can be CMS-initiated or provider-initiated
and can occur at anytime throughout the year. If it’s something that is provider initiated,
it’s important to include all of the facts and circumstances that support your hospice’s
request. When an exemption or an extension is granted,
hospice will not incur payment reduction penalties for failing to comply with the HQRP during
that time period. Now in contrast, the reconsideration is a
request for review of the non-compliance with the entire HQRP. So this non-compliance decision is made prior
to that 2-percentage point reduction in the annual payment that takes effect in October. And this period of reconsideration occurs
only once a year and only for those hospices that were determined to be non-compliant with
the HQRP. That would be non-compliance with either HIS
or CAHPS or for both HIS and CAHPS. And more detailed information regarding this
extension/exemptions and reconsiderations can all be found on the CMS website under
Hospice Quality Reporting. »» Thank you, Brenda. We’re sorry, we’ve run out of time for today’s
webinar. We have responded to several of the questions
that were submitted today. We apologize if you submitted a question and
it was not answered during this webinar. Some questions may require additional research. Please check later on the HQRP Requirements
and Best Practices Webpage. This concludes today’s webinar. Thank you for joining us today.

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