CMS Releases COVID-19 PHE Unwinding FAQs

The Centers for Medicare & Medicaid Services (CMS) has released numerous guidance documents and tools designed to help states prepare for the eventual end of the COVID-19 public health emergency (PHE), including a State Health Official Letter, Promoting Continuity of Coverage and Distributing Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID-19 Public Health Emergency (SHO #22-001, dated March 3, 2022).

New Grouper Edits For Home Health Claims

The Home Health (HH) Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating payment groups on HH claims. Of these edits, currently only a principal diagnosis not assigned to a clinical group causes HH claims to be returned to the provider. Other principal diagnosis code errors aren’t returned to the provider. In some cases, this causes processing problems.

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