Jurisdiction M (JM) Home Health and Hospice (HHH) POE Advisory Group (POE-AG) Minutes: April 17, 2025

Published 05/02/2025

Facilitators: Dan George, Elizabeth Brogdon, Charles Canaan, Michael Bibbins, Marlene Frierson, Belinda Marin

Attendees: 29

Welcome

Our Goals

  • Establishing and maintaining strong relationships with Palmetto GBA and our provider community 
  • Meeting with Palmetto GBA and the provider community on a quarterly basis 
  • Providing communication tools to facilitate thorough and prompt transfer of information 
  • Coordinating issues within the provider community to adequately reflect the concerns of the majority

POE-AG Goals and Purpose — HHH POE-AG Charter

Old Business: Prior POE-AG Suggestions/Recommendations — N/A

New Business: POE-AG Training Suggestions and Education Recommendations
Participating members have the opportunity to benefit the provider community by helping to guide Palmetto GBA educational strategy for the upcoming year.

Information to Share

Home Health

Hospice

RCD News

eServices

  • We've Made it Easier to Keep Your eServices Account Active: This enhancement is ideal for providers that do not utilize the eServices portal on a regular basis. This new change no longer requires the need to login. Users will receive an email that contains a link to keep your account active.
  • eServices UserManual (PDF): As of April 7, 2025, eServices’ eligibility screen responds with more detail about ‘Inactive Periods’ to why a beneficiary is/was ineligible for Medicare coverage during those periods. The reasons an individual is ineligible are:
    • Incarcerated
    • Deported
    • Not lawfully present

Open Discussion

Question: Can Palmetto GBA provide information on the process of how to request TPE Denial Rate recalculations?

Answer: If a provider receives favorable appeal decisions after the issuance of the letter and those results bring both the Charge Denial Rate (CDR) and Claim Line Denial Rate (CLDR) below the 20 percent thresholds, the provider may request a denial rate recalculation during the post-probe education session or via the Provider Contact Center.

Reminders

  • A provider should not request a recalculation prior to receiving their results letter. Fully favorable appeal results will be calculated into the letter denial rates when issued.
  • Recalculations should only be requested if the provider’s threshold is above the 20 percent CDR and CLDR thresholds, but favorable appeal results will take them below the thresholds
  • Partial denials and down coding of services are included in the CLDR and continue to count as a claim paid in error. A claim must have no errors to not be calculated in the denial rates.

Palmetto GBA is updating the Targeted Probe and Educate Program article to include this information.

Question: The group discussed that the Hospice Rate Calculator was not working properly.

Answer: Palmetto GBA did find a technical issue with the calculator and performed a fix for the issue on April 17, 2025. The calculator is now working properly. 

Question: How does the Medicare Hospice Benefit and the Programs of All-Inclusive Care for the Elderly (PACE) work together? If the beneficiary elected hospice and then enrolled in PACE with the hospice election continuing, how would that work?

Answer: Since comprehensive care is provided to PACE participants, those participants who need end-of-life care will receive the appropriate medical, pharmaceutical, and psychosocial services through the PACE organization. If a participant specifically wants to elect the hospice benefit from a certified hospice organization, the participant must voluntarily disenroll from the PACE program. The PACE organization will work with the SAA and CMS to facilitate the election of the hospice benefit and will work with the elected hospice organization to coordinate the transition of care.

At the time of PACE enrollment, the beneficiary should revoke the Medicare Hospice Benefit. If that was not completed, the beneficiary, PACE and the hospice should discuss and resolve the issue with an outcome that does not have the PACE enrollment and hospice election overlap. 

Resource: Section 10.2, of the Chapter 4 of 100-11.

Question: Has the “Meet with Your MAC” sessions be discontinued by Palmetto GBA? We found these sessions extremely helpful on resolving claim issues. What should we do if the Provider Contact Center (PCC) cannot help us?

Answer: Yes, Palmetto GBA ceased hosting Meet with Your MAC sessions in 2025. If you do have a claim issue, you want to go through the proper protocols of calling the PCC and have them escalate.

Question: For the hospice certifying physician claim edit, there is a nurse practitioner (NP) who has an invalid terminated physician enrollment in the Provider Enrollment Chain and Ownership System (PECOS). This issue is causing claim denials and how can this be corrected?

Answer: PECOS has stated that they cannot remove the incorrect record, and the edit finds the incorrect record and uses it, causing the denial. This is an issue that would be rare, with two known cases to date, and therefore is not listed on the Claims Payment Issues Log. CMS is researching the issue for a fix. It is important to remember that the Occurrence Code 27/date is not required on non-recertification claims and the edit doesn't apply to claims without Occurrence code 27/date. That would prevent denials on sequential claims. We will provide more information to the affected hospices when available.

Next Meeting: July 17, 2025. The 2025 HHH POE-AG dates are posted on the Provider Outreach and Education Advisory Group (POE-AG) website when available.


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