During this time of year, missed visit questions tend to come up more frequently.  Based on many years of survey experience, these questions and answers have been compiled as a guide.

 

Example is Patient is set up with an ordered frequency is 2 visits per week (Sunday-Saturday)

These are examples of what happens where “hands on visits” do not occur.

 

Q1. Go to client location, they are not home.  Fill out missed visit report.  Does this count against frequency per MCR?

A1. This was an attempted visit (hopefully it was previously scheduled with patient). So, it would satisfy the frequency if a missed visit is documented, stating the attempt.

 

Q2.  Did not get to patient for a visit at all–just not enough time, and no time to make up before the end of the Medicare week.  Filled out missed visit report.  Does this count against frequency per MCR?

A2. There was no attempt made, so frequency was NOT met and the visit needs to be made up during that Medicare week (Sunday-Saturday).

 

Q3.  Family says does not want visit for Thanksgiving Day, Friday, or Saturday.  Do you still have to make 2 visits during Sun-Wed or can one be a missed visit since family refused.

A3.   This can be documented as a missed visit as family refused, but does not satisfy the frequency. However, documentation should also be very specific to show that other visits that week were offered to meet frequency, and also refused.  Surveyors know that staff can, at times, do this for staff convenience rather than patient convenience, which is not allowed.

Please check with your software vendor to determine how to document each type in the software you use.

 

CGS implemented the Computer Telephony Integration (CTI) system on October 6, 2016. Please be advised that the CTI is unable to authenticate provider information when the Provider Transaction Access Number (PTAN) contains any alpha character (e.g., 123456X or 12X345). Therefore, at this time, if you have a PTAN with an alpha character, when calling the Provider Contact Center, select Option 9 for general questions. You will be directed to a CSR who will then follow the authentication process. CGS is working to update the CTI in order to authenticate this type of PTAN.

For more details about the CTI, please refer to the previously published resources listed below.

http://cgsmedicare.com/hhh/help/pdf/ivr_cs_guide.pdf

For the upcoming October 2016 Release, the CWF Hosts will not process claims beginning Friday, September 30, 2016 through Sunday, October 2, 2016. During this period, which is commonly referred to as \”dark days,\” the CWF Hosts will install the October 2016 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.

You should continue to submit your NOE/NOTR as the FISS system will be up, and will capture your submission date. They will not process until Monday October 3rd.

Eligibilities will NOT be updated since claims will not be processing. Therefore, plan to run an additional HIQA on Monday and again on Tuesday to make sure that you have captured all prior hospice information, and to verify if you needed a F2F for admission. If so, please complete no later than Tuesday.