Special Open Door Forum: Home Health Templates and Clinical Data Elements (CDEs)

Centers for Medicare & Medicaid Services Center

Special Open Door Forum:

Home Health

Templates and Clinical Data Elements (CDEs)

Thursday, March 1, 2018

3:00-4:00 pm Eastern Time

Conference Call Only

PCG will host a Special Open Door Forum (SODF) to allow physicians, provider and supplier professional associations, and/or all other interested parties to provide feedback on the Home Health Templates and CDEs that are posted on the CMS.gov website. The printable clinical templates and suggested CDEs describe the data elements that CMS believes would be useful in supporting the documentation requirements for coverage of Home Health Services as follows:

1. Plan of Care & Certification, and
2. Face-to-Face Encounter.

The Home Health Templates and CDEs are available on the CMS.gov website which can be accessed through the link below: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Electronic-Clinical-Templates/Other-Benefit-Templates/Other-Templates-home-health.html.

Providers and IT vendors can choose whether or not to use the printable clinical templates and/or the suggested CDEs. The suggested CDEs aren't a form, but a tool that IT vendors can integrate into electronic health record (EHR) systems to create prompts to assist providers with their medical record documentation for Medicare purposes. The templates and CDEs are intended to be a helpful guide but every section may not apply to all patients’ services and/or Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Providers can choose the information or CDEs that do apply. Once completed by the physician or other practitioner, the resulting documentation would become part of the medical record.

In fiscal year (FY) 2016, the Comprehensive Error Rate Testing (CERT) program reported an improper payment rate of 42.0 percent for Home Health claims. Of the CERT-reviewed claim lines in error, approximately 96.4 percent were found to have errors related to insufficient documentation with a majority of these errors resulting from a lack of documentation in medical records to justify Medicare coverage. The total projected improper payments for these claims was over 7 billion dollars.

To better assist providers in medical record documentation, for Medicare Fee for Service purposes, CMS has developed lists of clinical elements within a printable clinical template. This development will allow EHR vendors to create prompts to assist the practitioner when documenting. These Home Health Templates and CDEs are some of the first of many on the list of topics that CMS is currently working to address. Feedback and questions on our drafts can be sent to: clinicaltemplates@cms.hhs.gov.

We look forward to your participation.

Special Open Door Participation Instructions:

Participant Dial-In Number: 1-(800)-837-1935

Conference ID: 5379007 

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.

Thank you for your interest in CMS Open Door Forums.

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.