Archive for the ‘Home Health’ Category

Home Health Agency Patient Surveys Now Available for Consumers

Authored By: David W. Bufford

Consumers can now compare results from home health agencies (HHA) patient surveys on the Quality Care Finder website. These results are designed to create incentives for HHAs to improve quality of care, as well as to give patients additional information as to the type of care they will receive from a particular agency. The Centers for Medicare & Medicaid Services (CMS) also states one of the goals of such public reporting is to enhance accountability by increasing transparency. (more…)

Reactivation of Provider Number Requires Re-Certification Survey

Authored By: Todd J. Selby

On April 6, 2012, CMS issued a Survey and Certification Transmittal stating that when a Home Health Agency (“HHA”) deactivates its provider number (the provider number is now referred to as the CMS Certification Number or CCN), the HHA must be surveyed for compliance with the CMS Conditions of Participation (CoPs) for HHA’s if the HHA desires to reactivate its provider number. Deactivation of a provider number generally occurs if the HHA does not file claims for 12 consecutive months.

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Reducing Avoidable Hospitalizations for Nursing Facility Residents

Authored By: Todd J. Selby

As a means of improving care to residents residing in Medicare/Medicaid nursing facilities, CMS announced on March 15, 2012 an initiative to help reduce avoidable hospitalizations. Organizations interested in participating in this initiative must submit an application to CMS by June 14, 2012.

The goal of the initiative is to improve care for residents of nursing facilities by helping avoid costly and avoidable hospitalizations by funding organizations who would partner with nursing facilities to provide enhanced on-site services to nursing facility residents. CMS will commit up to $128 million to support this initiative. The initiative will be a collaboration between the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation as created by the Affordable Care Act.

Organizations eligible to participate in the initiative include physician practices, care management organizations, and other public and not-for-profit entities. Eligible organizations will propose its own evidence-based intervention and improvement strategy. The organization will have staff on-site at nursing facilities to provide preventive services and will provide coordination and communication among providers. CMS is hopeful that the initiative will help reduce hospital re-admissions of nursing facility residents. It has been estimated that 45% of hospital admissions of nursing facility residents could have been avoided. It is estimated that 314,000 admissions could have been avoided which cost the Medicare program $2.6 billion in 2005.

More information on how to apply for this initiative can be found here or by searching for CFDA 93.621 at www.Grants.gov . The eligible organizaion must include letters of support from the State Medicaid Director and State Survey and Certification Director, and letters of intent from at least 15 nursing facility partners. Notices of Intent are due by April 30, 2012.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

New York Times Article Discusses Move to Managed Home Care

Authored By: David W. Bufford

An article in the New York Times discussed a growing trend away from the utilization of nursing facilities in favor of managed care and home care. In light of reimbursement cuts from Medicare and Medicaid, the push to home health, managed care, and the Program of All-Inclusive Care for the Elderly (PACE) has received enthusiastic response from some patients and providers alike.

Revised Home Health Agency Survey and Certification Activities Related to a Change of Ownership

Authored By: Todd J. Selby

CMS recently issued guidance to the State Survey Agencies regarding changes to the survey procedures for Home Health Agencies (HHAs). Effective January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) Home Health Prospective Payment System (PPS) final rule amended the regulations for certification activities related to HHAs. CMS’s goal in implementing these changes is to ensure that a newly-sold HHA is in compliance with the applicable Conditions of Participation (CoPs).

Specifically, the revised policies affect the enrollment of HHAs that undergo a change of ownership (CHOW) (i) within three (3) years of their initial Medicare enrollment; or (ii) within three (3) years of a previous change in majority ownership. A change in majority ownership is a transaction in which the HHA experiences more than a fifty percent (50%) change in direct ownership by either an individual or an organization (i) during the thirty-six (36) months after the HHA’s initial Medicare enrollment; or (ii) thirty-six (36) months after its most-recent change in majority ownership.

If an HHA is subject to the “36-month rule,” then the provider agreement and Medicare billing privileges do not transfer to the new owner. Consequently, the new owner must obtain an initial survey from the State Survey Agency or a CMS-approved accreditation organization to participate in the Medicare program.

However, four (4) exceptions to the new requirements exist. The HHA is not subject to the new requirements: (1) the HHA has submitted two (2) consecutive years of full cost reports; (2) the HHA parent company is undergoing an internal corporate restructuring such as a merger or consolidation; (3) the owners of an existing HHA are changing the existing business structure but the owners remain the same; or (4) an individual owner of an HHA dies.

The Memorandum can be accessed here.

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney,
or Todd Selby at tselby@hallrender.com or 317.977.1440;
Brian Jent at bjent@hallrender.com or 317.977.1402;
or David Bufford at dbufford@hallrender.com or 502.568.9368.

OIG Posts Video Guidance on Self-Disclosure

Authored By: David W. Bufford

As part of their on-going video series, the Office of Inspector General (OIG) has posted a video on their self-disclosure protocols.

Self-disclosure is a key element of an effective compliance program, and can possibly reduce any civil monetary penalties (CMPs) associated with a violation or instance of noncompliance.

The OIG has provided many videos in this series that are beneficial for long-term care providers. The full list of videos is available on the OIG Website.

CMS Postpones Two Anti-Fraud Initiatives

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns. Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012. (more…)

CMS Clarifies Guidance on PPACA Mandatory Medicaid Terminations

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) released updated guidance on Section 6501 of the Patient Protection and Affordable Care Act (PPACA) that requires state Medicaid agencies to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other state Medicaid plan. (more…)

OIG Releases Provider Compliance Videos

Authored By: David W. Bufford

In December, the Office of the Inspector General (OIG) released an initial series of videos aimed at providers that focus on compliance issues. These videos are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. Health & Human Services Inspector General Daniel Levinson stated the videos are intended to help providers further enhance their compliance efforts. (more…)

CMS Revises Initial Certification Process for HHAs

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (CMS) has issued revisions to the process Home Health Agencies (HHA) must undergo prior to initial certification. The revised process adds an additional review of enrollment criteria performed by the Regional Home Health Intermediary (RHHI) or Medicare Administrative Contractor (MAC). (more…)

Proposed Wage Regulations for Home Care Workers

Authored By: David W. Bufford

The Department of Labor published a Notice of Proposed Rulemaking in late December aimed at giving the nation’s nearly two million home care workers minimum wage and overtime protections. These workers have long been working under an exemption from the Fair Labor Standards Act (FLSA) as “companion” employees. (more…)

CMS Contractors to Review of Denials Relating to Face-to-Face Requirements for HHA Services

Authored By: Kendra Conover

The Centers for Medicare & Medicaid Services (“CMS”) has recently instructed contractors to reopen certain claims that were previously denied for failure to meet the “face-to-face” requirements in certain circumstances and assuming all content requirements of the certification and the face-to-face documentation are otherwise met. It came to CMS’ attention that certain claims were being denied by some CMS contractors for patients who use Home Health Agency (“HHA”) services following an acute or post-actue stay when:

The HHA uses a single form (i.e., 485) for the plan of care and the certification with a single signature by the community physician who assumes oversight of the patient’s home healthcare.
The physician who cared for the patient in the acute or post-acute setting is the certifying physician and has provided and signed attached documentation of the face-to-face encounter.

CMS does not mandate that a specific form be used for the certification or plan of care. Many providers, however, have chosen to use the no-longer-required CMS-485 form to satisfy the plan of care and the certification. Since April 2011, providers who use this form typically attach the face-to-face encounter documentation to the CMS-485, as an addendum. This is because the CMS-485 contains only one physician signature line for both the plan of care and the certification of eligibility.

In the case of patients admitted to an HHA following an acute or post-acute stay, the Medicare Benefit Policy Manual (“BPM”) language allows for one physician to sign the certification and face-to-face documentation, while a different physician can sign the plan of care. If the face-to-face encounter documentation and the CMS-485 form collectively satisfy all of the certification and plan of care content requirements as defined in Chapter 7 Section 30 of the BPM, Medicare contractors have been directed to accept a CMS-485 form signed by the community physician who assumes oversight of the patient’s home healthcare with an addendum containing the face-to-face encounter documentation requirements signed by a physician who cared for the patient in an acute or post-acute setting, to satisfy the certification, face-to-face encounter, and plan of care requirements. In this scenario, the certifying physician is the acute or post-acute physician, has initiated content on the CMS-485, and has completed and signed the face-to-face encounter documentation. The physician who signs the CMS-485 assumes care for the patient’s home healthcare.

Additionally, CMS acknowledged that some contractors are denying claims for failure of the acute or post-acute physician to identify the community physician who will assume care for the patient. CMS has not mandated the acute or post-acute physician to follow a specific documentation protocol to hand-off a patient to the community physician. Therefore, these claims will be reviewed as well.

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440, or Kendra Conover at kconover@hallrender.com or 317.977.1456

Nursing Home’s Failure to Notify Leaves Beneficiary Not Liable for Custodial Care Services

Authored By: David W. Bufford

A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25. The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct. 25, 2011) concerned the application of 42 C.F.R. 411.404, which states a beneficiary is considered to have known custodial care or services that are not reasonable and necessary are not covered services under Medicare, provided the beneficiary received adequate notice the services are not covered under Medicare. (more…)

Medicare Provider Revalidation Requests

Authored By: Brian D. Jent

The Centers for Medicare & Medicaid Services has posted a list of providers who have been sent a request to revalidate their Medicare enrollment information. You can access and review the list, then select “Revalidation Phase 1 Listing.” The list will be updated monthly and providers are encouraged to review the list. If you are listed but have not received the request, contact your Medicare Administrative Contractor. Please note that revalidation applications are due sixty (60) days from the date of the request.

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440; Brian Jent at bjent@hallrender.com or 317.977.1402; or David Bufford at dbufford@hallrender.com or 502.568.9368.

CMS Extends Timeline for Provider Revalidation

Authored By: David W. Bufford

The Centers for Medicare & Medicaid Services (“CMS”) has reevaluated the revalidation requirements in the Affordable Care Act (“ACA”), and believe the ACA allows for the extension of the revalidation period for an additional two years. This will extend the deadline for revalidation through March of 2015. Providers are reminded that if they have already received their notice to revalidate, they must complete the revalidation within the original time-frame. This only will extend the time-frame CMS has to issue the revalidation notices. This also does not affect the screening category certain providers or suppliers are assigned for revalidation.

DMEPOS Competitive Bidding Round 2 is Coming Soon

Authored By: Kendra Conover

The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2 and the national mail-order competitions are coming soon. Though the bidding schedule has not yet been released, suppliers interested in bidding should begin their preparations now to help avoid unnecessary delays or rejection of a bid application.

Any supplier who plans to participate in the Bidding Program Round 2 or Mail Order Competitions should begin its preparation now by:

Updating the Supplier’s Information with National Supplier Clearinghouse (NSC). If a supplier’s file is not current, the supplier may experience delays and/or be unable to register and bid. DMEPOS suppliers should review and update all supplier information on file with NSC, including but not limited to the name, Social Security number, and date of birth for all authorized official(s), as well as the correspondence address. DMEPOS suppliers can update their enrollment via the internet-based Provider Enrollment, Chain and Ownership System (PECOS) or by using the 7/11 version of the CMS-855S enrollment form.

Obtain All Necessary Licenses. Before a supplier submits a bid for a product category in a Competitive Bidding Area , the supplier must have all required state licenses for that product category on file with the NSC. Every location must be licensed in each state in which it provides services. NSC may reject a bid if any license are expired or missing from a supplier’s enrollment file.

Obtain and Maintain Accreditation. Suppliers must be accredited for all items in a product category in order to submit a bid for that product category. Suppliers should verify they are accredited for all items in any product category they plan to bid on.

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440, or Kendra Conover at kconover@hallrender.com or 317.977.1456.

2012 Medicare Home Health Payment Changes

Authored By: Todd J. Selby

On October 31, 2011, the final rule (Rule) to update the Home Health Prospective Payment System (HH PPS) for Calendar Year 2012 was published in the Federal Register. As a result of the Centers for Medicare & Medicaid Services (CMS) implementing the Rule, home health agencies (HHAs) will experience a decrease in payments of approximately 2.31% in 2012. CMS adjusted the payments based on a provision in the Affordable Care Act that applies a 1% reduction to the 2012 home health market basket and accounts for growth in the aggregate case-mix. CMS also finalized a 3.79% reduction to HH PPS rates for 2012 and an additional 1.32% for 2013. Adjustments are made annually to home health payment rates to account for inflation in the costs of goods and services that are provided by HHAs.

Structural changes were also made by removing certain codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights. These changes are intended to increase payment accuracy and reduce growth in the aggregate case-mix.

Under the Rule, it will no longer be necessary for a patient to be seen by a certifying physician or an allowed non-physician in order to qualify for home health services. If a patient has recently been under the care of a physician in an acute or post-acute care facility, the physician can inform the certifying physician; thus, eliminating the need for the certifying physician to see the patient.

Additionally, under provisions of the Deficit Reduction Act of 2005, HHAs receive an adjustment to their payments based upon their submission of quality data. Therefore, if an HHA submits the required data, it will receive a payment update of 1.4% for 2012. If an HHA does not submit the required data, it will experience a negative payment update of -0.6% for 2012.

The Rule can be accessed at http://federalregister.gov/inspection.aspx .
Additional information regarding the Home Health Prospective Payment System can be found at http://www.cms.gov/HomeHealthPPS/ .

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440; Brian Jent at bjent@hallrender.com or 317.977.1402; or David Bufford at dbufford@hallrender.com or 502.568.9368.

OIG Publishes 2012 Work Plan

Authored By: Todd J. Selby

On October 5, 2011, the Office of Inspector General (OIG) published its proposed Work Plan for Fiscal Year 2012. As in the past, the Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The 2012 Work Plan contains several new areas of focus by the OIG that potentially will impact current operating practices of nursing homes and hospices and the relationships between these types of providers. More specifically, areas of increased scrutiny are (i) nursing home compliance plans; (ii) billing patterns of Part B provider services during non-Part A nursing home stays; and (iii) hospice marketing practices and financial relationships with nursing facilities.

The OIG will review Medicare- and Medicaid-certified nursing homes to ensure the implementation of compliance plans as a part of their day-to-day operations. The compliance plans will be reviewed to ensure they contain the required elements of the OIG’s compliance program guidance. Under the Affordable Care Act, nursing facilities must operate a compliance and ethics program to prevent and detect criminal, civil and administrative violations and to promote quality of care. The Centers for Medicare & Medicaid Services (CMS) is charged with overseeing the program and incorporating the requirements into the Medicare Requirements of Participation. CMS also must issue regulations by 2012, and nursing facility providers must have compliance programs in place by 2013.

Billing patterns of nursing facilities and Medicare Part B providers will be scrutinized to confirm that services provided by Part B providers to nursing facility residents during a non-Part A stay are billed directly by suppliers and providers. More particularly, the OIG will analyze podiatry, ambulance, laboratory and imaging services for conformity with this requirement.

Lastly, the OIG will closely examine and monitor hospices’ marketing materials and practices and their financial relationships with nursing facilities. Recently, the OIG reported that a high percentage of hospice claims for services to Medicare Part A-eligible nursing facility beneficiaries did not meet the Medicare coverage requirements. Observations by MedPAC, an independent congressional agency that advises Congress on issues affecting Medicare, suggest that hospices and nursing facilities may be involved in inappropriate enrollment and compensation relationships. Consequently, practices of hospices with a high percentage of their patients in nursing facilities will undergo increased inspection as well as those hospices that aggressively market their services to nursing facility residents.

A complete copy of the 2012 Work Plan can be accessed at http://www.oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf

If you have questions or concerns regarding the foregoing or would like additional information, please contact your regular Hall Render attorney, or Todd Selby at tselby@hallrender.com or 317.977.1440; Brian Jent at bjent@hallrender.com or 317.977.1402; or David Bufford at dbufford@hallrender.com or 502.568.9368.

Update on NLRB Actions

Authored By: David W. Bufford

As Mr. Lyman pointed out last week, the National Labor Relations Board (NLRB) now requires private employers to post a Notice of Employee Rights under the National Labor Relations Act (NLRA). A recent New York Times article on this new requirement discusses an upcoming decision by the NLRB that is expected to address unionization of long-term care employees specifically. Any developments concerning this decision will be included in a future posting as they become available.

Should you have any questions, please contact:

Steve Lyman at 317.633.4884 or slyman@hallrender.com;
Todd Selby at 317.977.1440 or tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com, or your regular Hall Render attorney.

NLRB Notice Requirement Affects Long-Term Care Providers

Authored By: Stephen Lyman

The National Labor Relations Board (NLRB) just issued a final rule that will require most private employers, including those that are long-term care providers, to post a Notice of Employee Rights under the National Labor Relations Act (NLRA). The notices must be posted by November 14, 2011. The text of the notice is available in the final rule (starting on page 185), however this is not the final form of the notice. (more…)

Revised CMS-855 Forms Published, New CMS-855O to Order and Refer Items

Authored By: David W. Bufford

The US Office of Management and Budget has approved the revised Medicare Provider-Supplier Enrollment Applications, the CMS-855 forms. These updates to the 2008 versions include multiple changes to comply with enhanced disclosure requirements. Such changes include: (more…)

CMS Home Health, Hospice & Durable Medical Equipment Forum Today at 2 p.m. EST.

Authored By: David W. Bufford

The proposed agenda for today’s Home Health, Hospice & DME/Quality Open Door Forum is as follows: Hospice wage index final rule published; Hospice CR 7518 with FY 2012 updated rates and cap amount issued; Timeline for Hospice CAP changes; HHCAHPS Updates. This is scheduled for Wednesday, August 17, 2011 from 2:00pm-3:00pm EST.

Resistration for this Open Door Forum is available here.

What Risk Categories Mean to Providers and Suppliers

Authored By: David W. Bufford

Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events which could elevate screening categories. While these posts focus on long-term care providers, the enrollment revalidations and screening categorizations are applicable to all Medicare providers and suppliers. (more…)

Update to Revalidation Enrollment Procedures

Authored By: Todd J. Selby

As an update to the previous post on the revalidation enrollment procedures it is important for hospices, home health agencies, and DMEPOS to know what level of screening they will receive from the Medicare Administrative Contractor (“MAC”). In some instances these providers and suppliers will be screened at either a “high” or “moderate” level of risk by the MAC. The risk category assigned corresponds with the amount of possible fraud and abuse that CMS believes is applicable to providers and suppliers.

All hospices (current and newly enrolled) will be screened at a “moderate” level of risk. Newly enrolling home health agencies will be screened at a “high” level of risk. The only other “high” category is newly enrolling DMEPOS. DMEPOS or home health agencies that are publicly traded on the NYSE or NASDAQ are classified as “limited” risk. Currently enrolled home health agencies and DMEPOS will be screened at a “moderate” level of risk.

It is VERY important that currently and newly enrolled hospices, home health agencies and DMEPOS accurately complete the revalidation process when completing the applicable CMS Form 855 due to the level of screening it will receive from the MAC. It is also VERY important to know that the CMS Form 855 has recently changed and requires, in some instances, much more detailed information. For example, the providers are required to provide much more detail on its ownership and operating structure.

Should you have questions on the revalidation process or the new CMS Form 855, please contact Todd Selby at 317.977.1440 or tselby@hallrender.com, Brian Jent at 317.977.1402 or bjent@hallrender.com, David Bufford at 502.568.9368 or dbufford@hallrender.com, or your regular Hall Render attorney.

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

Authored By: David W. Bufford

As of March 2011, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria in the Medicare provider/supplier enrollment process. Newly enrolling and revalidating providers and suppliers are placed in one of three categories – limited, moderate, or high – each representing the level of risk to the Medicare program for that provider’s/supplier’s particular category. The categorization will determine the degree of scrutiny the Medicare Administrative Contractor (MAC) will utilize when screening the enrollment application. (more…)

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