CradleMRx releases update for OASIS C2 2017

CradleMRx is ready for the OASIS C2 2017 update.  You will notice that previous OASIS will remain functional under the old OASIS C1 ICD-10 format.  Any new OASIS, as of January 1st, 2017, will be under the newly updated OASIS C2 format.

Background Information from CMS

Per CMS, “effective January 1, 2017, OASIS-C2 is the current version of the OASIS data set.  It was developed from OASIS-C1/ICD-10 to accommodate new data being collected for the Home Health Quality Reporting Program in support of the IMPACT Act.” For full details visit the CMS site here.

CradleMRx’s new OASIS C2 2017 uses updated technology for optimum speed.  It will also implement augmented compliance features where applicable by showing the current selection in the given sections of the OASIS in an ORANGE box.

Expected Changes

  •  The OASIS C2 version includes three new standardized items (M1028, M1060, GG0170c), along with modification to and renumbering of select medication and integumentary items to standardize with other post-acute settings of care (M1311, M1313, M2001, M2003, and M2005).
  •  The lookback period and item number was changed in five items (M1500, M1510, M2015, M2300 and M2400).
  •  Formatting changes were made throughout the document to convert multiple check boxes to a single box for data entry, where responses are mutually-exclusive, and to change the numbering for pressure ulcer staging from Roman to Arabic numerals.
  •  The complete set of OASIS-C2 data items can be found in the Downloads section here.

National Nurses Week – May 6-12

National Nurses week is celebrated annually starting on May 6th, which is also known as Nurses Day, and continues all week through May 12th this year. In honor of all nurses, everyone at Cradle salutes you for the daily caring gestures and positive impact you bring to the world daily.

The Department of Health and Human Services Secretary Kathleen Sebellius issued a statement which is worth reading for its insightful information about the impact of the Affordable Care Act has on the nursing world.

To read the full article, click here.

Texas and Florida Rank on Top in Medicare Home Health Utilization Report

Based on The Remington Report, which shows state-by-state data on reimbursements, patient count, patient visits, as well as their averages, Texas ranks highest in reimbursements followed by Florida.

The national average:

  • Total Reimbursement: $19,533,203,558
  • Patients: 3,452,459
  • Visits: 124,698,461
  • Average Reimbursement Per Patient: $5,691
  • Average Visits Per Patient: 36

On a comparison of the top two states with regards to Total Reimbursement, namely Texas and Florida:

  • Total Reimbursement:  Texas (1st) at $3,074,853,160 followed by Florida at $2,278,311,770
  • Patients: Texas (1st) at 368,722 followed by Florida (2nd) at 356,502
  • Visits: Texas (1st) at 22,074,537 followed by Florida at 16,877,067 (2nd)
  • Average Reimbursement Per Patient: Texas (1st) at $8,339 whereas Florida (6th) at $6,391
  • Average Visits Per Patient: Texas (2nd behind Oklahoma) at 60 whereas Florida is 5th at 47

To view the full report, click here..

HIPAA 5010 Certification for Claims Submission, Claim Status, Eligibility Check and ERN

Please be advised that Cradle Solution Inc. (CradleMRx) has been approved to submit the 5010 version.

As of the date of this blog entry, we are simply awaiting Palmetto GBA’s update of their approved vendor list.

In preparedness for the upcoming change to EDI 5010 for electronic claim transmission to Fiscal Intermediaries, please review which of the following items apply to your agency.

1. If you were subscribed to our Eligibility, Claims and Remittance (ECR) package prior to 11/15/2011, or if you were submitting claims yourself using GPNet prior to 11/15/2011, you do not have to do anything as we have already taken care of updating your Submitter ID to the new 5010 format for you.

2. If you received your submitter ID after 11/15/2011, you were automatically setup for the new 5010 format. This was automatic since Palmetto GBA stopped all 4010 setups on that date.

3. If you have a Submitter ID from prior to 11/15/2011 and intend to start using our ECR or intend to submit EDI yourself via GPNet, you will need to update your Submitter ID to the new 5010 format by filling out the following form per sample below.


4. File Submission and Acknowledgement: Submitted (ANSI 837) Files now get both a 999 Acknowledgement File and a Response File (277CA) in EDI format. None of these files are easily readable without translation software. This is a critical change from 4010 version.

5. ECR users will get translated versions of both responses while Non ECR users will not be able to easily read there responses. ECR users are CradleMRx users who automatically submit their claims through the automated submission channel. 999 Acknowledgement File translations will not be available to Manual claim file submitters.

6. All providers are henceforth required to provide their 4 digit zip code extension. You can do that from inside CradleMRx by going to Setup and updating the Home Health information with the 4 digit zip code extension e.g. 77074-5124

7. New!—–Sample 999 Acknowledgement, available to ECR Subscribers, automated submitters only.

8. New!—– Sample Claim Status ANSI 277CA

CMS is Converting – OASIS Submission Changes

With CMS converting from AT&T to Verizon, how you submit your OASIS data to the state will also change. This new change affects only how you send OASIS data; it does not affect when you send (30 days from M0090 rule) OASIS data.

For more information direct from CMS click on the following CMSNet Information links:

CMS Posts List of Providers Sent Revalidation Letters

Due to recent requests by providers, CMS has released the first list of providers that were sent revalidation letters (Phase 1). If you enrolled prior to March 25, 2011 you may have received a letter. Letters will continue to go out up to March 23, 2015. For more information on the revalidation of Medicare provider enrollment, check out MLN Article 1126: Further Details on Revalidation of Provider Enrollment Information.

A sample letter as well as the Revalidation Phase 1 Listing can both be found in the Medicare Provider Supplier Revalidation Page.

If you are on the list but have not received the revalidation letter, please contact your MAC directly. Their numbers can be found at the Medicare Fee-for-Service Provider Enrollment Contact List.

Why a 2% Reduction in Medicare Payments?

There are a few reasons your Home Health Agency (HHA) might be subject to 2% Reduction in Medicare payments for calendar year 2012.

  1. Your Home Health Agency’s OASIS were not transmitted within 30 days of the Completed date (M0090) looking at a time period of July 1, 2010 to June 30, 2011
  2. Your Home Health Agency qualified for CAHPS but did not participate in an HH-CAHPS dry run in third quarter 2010 and then continue monthly data submission to an approved CAHPS vendor.

For more information:

Application Updates: Themes, Performance, ECR

Our current customers may have noticed some changes in CradleMRx. We’ll detail a few of the changes here so existing users can get up to speed, and new users can see our commitment to home health agencies.

Eligibility, Claims, and Remittance

Perhaps our largest addition has come in the form of an optional ECR module. With this addition, your clinicians will have nearly instant access to Medicare eligibility checks, batched claims, and remittance tracking for billed items.

We can integrate your remittance vendor’s protocols so all you need to do is tell us your vendor.

User-Selectable Themes

Existing users have probably noticed our transition to a much cleaner application interface. We’ve been working diligently to ensure the application is easily scannable and is not visually cluttered. At the same time, we are working to keep everything you need at your fingertips.

With this interface change, we’ve also added the ability for users to change themes to suit their personal preference. When you change the visual theme, your settings are retained even if you log in to a different computer (login screen theme will change once you log out completely from the application).

We have several themes available to choose from, and will be adding more accessible high-contrast themes in the future.

Performance Tuning

With our default theme changes, we’ve actually combed through the application and identified several areas where performance could suffer on older computers or slower internet connections. We are also adding physical servers to further distribute our user load, so CradleMRx should be faster than ever!

Medicare Policy Updates: Partial Episode Payments

Patients must be informed of transfer procedures.

The Centers for Medicare and Medicaid services recently released updates to some provisions within the Medicare Final Rule. These adjustments make minor changes to some of the payment policies regarding Home Health episodes and patient transfers.

This information was released February 16th of this year, to be effective January 1st and implemented March 1st.

An intervening event (as defined by Medicare) occurs when a patient either:

  1. reaches their treatment goals or
  2. transfers to different Home Health agency before the end of the 60-day episode, then returns to the original agency for treatment.

When this situation occurs, several factors can influence which provider will receive payment, and for how much. If a patient has returned for treatment after reaching their goals or transferring, a new 60-day episode begins and a new plan of care and certification are required. Medicare payment for the previous episode is adjusted based on the amount of time the patient was under the agency’s care. This adjustment is the Partial Episode Payment (PEP).

However, if a patient has transferred because of a Skilled Nursing or rehabilitation admission, and returns to the initial agency for treatment within the same 60-day period, Medicare considers this a single episode covering the time from initial certification, including admissions, and the PEP would not apply. Rules regarding transfers between agencies have also been modified to adhere to certain new patient rights requirements. If a Medicare beneficiary elects to transfer to another agency, the receiving agency must document that they have informed the patient that the original agency will no longer receive payment for services rendered after the transfer date.

The new home health agency must also inquire as to whether the patient is currently under an established plan of care, by accessing the Regional Home Health Intermediary system. If so, the receiving agency is required to document that they have contacted the original agency and provided notification of the transfer. If this documentation can be provided by the receiving Home Health agency, the initial agency will not be eligible to receive the PEP or reimbursement for any overlapping care.

If the receiving agency cannot provide this documentation, their final claim will be canceled by Medicare and the original provider of service will receive full payment for the episode. Any disputes occurring between agencies regarding this policy are to be resolved through the Regional Home Health Intermediaries.

Timely Filing Matters

Each year, professional and institutional providers are required to write-off a portion of their expected payment because of untimely filing of healthcare claims. Whether your contract is with a commercial payer, Medicare, or Medicaid, knowing what is required to submit a timely claim can result in fewer losses and more efficient processing and payment of each claim.

As you probably know by now, the statutory time limit for filing Medicare claims has been adjusted as part of implementing the Affordable Care Act. At one time, providers were given anywhere from fifteen to twenty-seven months to submit a claim for payment, depending on the date services were rendered. However, effective January 1st of 2010, the timely filing period was reduced to a maximum of twelve months from the date of service.

The new filing deadline seems straightforward at first, but there are several details our agencies need to be aware of. There are certain situations in which the timely filing limit may be sooner or later than twelve months from the service date. Knowing the criteria for these exceptions will help your agency fight for accurate reimbursement of any claims erroneously denied for timely filing.

For professional providers billing for services rendered over a specific time span, Medicare will determine timely filing based on the “from” date of service. This ruling prevents Medicare claims processors from issuing line-item denials within the claim, provided it has been submitted within twelve months of the initial treatment date. Alternatively, if the claim’s submission date falls after the twelve months following the first service date, Medicare will split the claim by line item detail and issue individual denials for each date that was not filed timely.

Specific exceptions to the timely filing rule pertain to administrative and patient eligibility issues. In the event of an administrative error on the part of Medicare or its representatives, the timely filing limit is extended to six months from the date that the provider received notice of the error, to allow sufficient time to submit the claim. Additionally, providers are given six additional months to file when patient becomes retroactively eligible for Medicare and services were provided during the retroactive coverage period. If a patient is eligible for Medicaid at the time treatment is rendered, and later becomes retroactively entitled to Medicare, the provider is given six additional months from the time that Medicaid recoups its initial payment to submit a claim. This also applies if the patient is retroactively dis-enrolled from a Medicare managed care plan and the managed care carrier recoups its initial payment.

It’s a good idea to verify the accuracy of all denials you receive from Medicare, as there are instances in which your agency may still be able to recover payment of a denied claim. In the event of a timely filing rejection, check to be certain that none of these special situations apply to your claim. You may be surprised to learn that a simple appeal with adequate documentation can result in payment of a claim that might otherwise be abandoned.

For more information on this topic, visit