June 2015

The 2016 Hospice Proposed Rule: A Look at Clinical Relatedness, Diagnosis Coding and Non-Hospice Spending


Simione Healthcare Consultants is pleased to publish this first of several updates to review key components of the FY2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting proposed rule.  This installment covers clinical relatedness, including diagnoses on claims and non-hospice spending.


With the April 30 release of the 2016 Hospice Wage Index Proposed Rule, CMS continues to remind providers of the original requirements for hospices to cover 'virtually all' care required by hospice beneficiaries at the end of life. "In the December 16, 1983, Hospice final rule (48 FR 56010 through 56011), regarding what is related versus unrelated to the terminal illness, CMS stated: '...we believe that the unique physical condition of each terminally ill individual makes it necessary for these decisions to be made on a case-by-case basis. It is our general view that hospices are required to provide virtually all the care that is needed by terminally ill patients.' Therefore, unless there is clear evidence that a condition is unrelated to the terminal prognosis, all conditions are considered to be related to the terminal illness. It is also the responsibility of the hospice physician to document why a patient's medical needs will be unrelated to the terminal prognosis."  


Join Us for a Complimentary Webinar


Key Elements of the 2016 Hospice Proposed Rule

Tuesday, June 30, 2015 at 3-4 pm EDT


Experts at Simione Healthcare Consultants have prepared an overview of the CMS 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Proposed Rule. Topics will include clinical relatedness, diagnoses on claims, comprehensive assessment, non-hospice spending, clinical quality reporting, survey readiness, program integrity, and several important financial considerations. 




Lisa Lapin, Principal

Julia Maroney, RN, MHSA, Director

Kim Skehan, RN, MSN, Senior Manager


The CMS 855A for Home Health and Hospice


Providers enrolling in the Medicare program are required to complete the CMS 855A in order to

obtain billing privileges.  The CMS 855A Medicare Enrollment Application must also be completed whenever enrollment information needs to be added, deleted, or changed.  Most importantly, information must be submitted in a timely fashion to maintain billing privileges.


In completing the 855A, providers are being asked to certify that they are in compliance with all applicable federal and state licensure requirements.  This includes certifying that they do not employ or contract with individuals or entities that are excluded from the Medicare or Medicaid Program.  More information on exclusions  


Advance Your Sales Leadership at Our 2nd Annual Sales Management Summit and Sales Training in September

Simione Healthcare Consultants is pleased to announce September dates for its annual Sales Management Summit and Square One Boot Camp sales training.  Training includes several key enhancements, including lower pricing and one less hotel night with no need to travel on a Sunday! The training fee is now $1,495 per person (formerly $1,895), and the training schedule is Monday 1 -5:30 pm, Tuesday, 8:30 am-5:30 pm, and Wednesday, 8:30 am-2 pm. Square One Boot Camp includes separate, specialized tracks for home care and hospice. Join us for these great opportunities to improve your referral management efforts!

September 14-16, 2015
Simione's 2nd Annual Sales Management Summit
 A Conference and Networking Event at The Cosmopolitan at Las Vegas, NV
(program agenda forthcoming in July)

September 21-23, 2015
Square One Boot Camp
Home Care & Hospice Sales Training at Courtyard by Marriott, Chapel Hill, NC


June 12Healthcare Compliance Association Seattle Regional Conference, Doubletree Seattle Airport, Seattle, WA
June 24-26 Homecare Homebase Users Conference, Worthington Renaissance Hotel,
Ft. Worth, TX
June 28-30NAHC Financial Management Conference & Exposition, Gaylord Opryland Hotel, Nashville, TN 
July 21-23NHPCO Virtual Conference (online at www.nhpco.org
July 28-30Home Care Association of Florida Annual Conference & Trade Show, Walt Disney World Dolphin Hotel, Orlando, FL
Aug 12-13The Texas Association for Home Care & Hospice 46th Annual Meeting, Moody Gardens Resort & Conference Center, Galveston, TX


Click on the free webinar icon at right, and select the webinar date on calendar for the link to registration. All webinars are held 2-3 PM or 3-4 PM Eastern time.
June 11  Financial Fitness: Exercise Your Options
June 30  Highlights for Successful Hospice Operations (2016 Proposed Rule)
July 1      Five Strategies for Sales Excellence in Home Care and Hospice 


Founded in 1966, Simione™ Healthcare Consultants provides comprehensive business solutions for home health and hospice in the areas of finance, operations, cost reporting, compliance and risk,  sales and marketing, information technology, and mergers and acquisitions.  Simione's experts and tools support performance improvement across the healthcare continuum, engaging hospitals, health networks and agencies to improve quality, reduce costs, and minimize risk for more effective delivery of patient care.