Data collected and analyzed by the Office of Inspector General (OIG) since 2010, indicate that home health agencies (HHAs) are predisposed to commit Medicare fraud, waste and abuse. In 2010, Medicare inappropriately paid $5 million for erroneous claims submitted by HHAs. With one in four claims being suspect, the OIG established six (6) criteria that identify HHAs submitting potentially fraudulent claims and/or employing questionable billing practices. Primarily, these criteria are based on higher than average payments, visits, late episodes, therapy visits and Medicare payment amounts per beneficiary, as well as a higher than average number of beneficiaries. (more…)
Archive for the ‘Hospice’ Category
Inappropriate and Questionable Billing by Medicare Home Health Agencies
Authored By: Todd J. Selby
CMS Releases Hospice Wage Index for FY 2013
Authored By: David W. Bufford
This afternoon, the Centers for Medicare & Medicaid Services (CMS) issued a notice updating the Medicare Hospice Wage Index with an estimated 0.9% increase in payments for FY 2013. The payment increase is the net result of a 1.6 percent increase in the hospital market basket update, which is offset by a 0.7 percentage point decrease in payments to hospices due to updated wage index data and the fourth year of CMS’ 7-year phase-out of its wage index budget neutrality adjustment factor (BNAF). The notice also provides clarification on additional diagnoses reporting on hospice claims and updates on hospice payment reform and hospice quality reporting.
The notice will be published in the Federal Register on Friday, but Hall Render has an advanced copy available here.
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.
Collaborative Group Releases LTPAC Health Information Technology Road Map for 2012 -2014
Authored By: David W. Bufford
Since 2005, a group of associations, such as LeadingAge, AHCA, AMDA, and many others, has hosted an annual summit to discuss the information technology (IT) issues long term care and post acute care providers face. The group, known as the Long Term and Post Acute Care (LTPAC) Collaborative, publishes a Road Map for LTPAC providers to follow for the next 24 months in their adoption of IT systems. The specifics of the 2012-2014 Road Map are discussed on the Hall Render Health Information Technology Blog. (more…)
Another Antipsychotic Measure Fails to Pass
Authored By: David W. Bufford
In an on-going push to regulate the use of antipsychotic medications in nursing facilities, another piece of legislation has failed to pass Congress. The Senate did not pass a proposed regulation that would have standardized protocols for obtaining informed consent before administering antipsychotics for off-label use. (more…)
BLS Report Details Time Spent on Elder Care
Authored By: David W. Bufford
Since 2003, the Bureau of Labor Statistics (BLS) has asked Americans to detail how their time was spent during the last 24 hours. Derived from a sample of 12,500 respondents, the American Time Use Survey (ATUS) details the average number of minutes spent daily in traffic, on the phone, shopping, cooking, etc. Only last year was a question concerning elder care added to a surprising result. (more…)
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.
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.
Changes to Hospice Discharge Coding Coming this Summer
Authored By: David W. Bufford
The Centers for Medicare & Medicaid Services (CMS) has published a transmittal detailing changes for coding hospice discharges, which will provide greater clarity as to why the patient has been discharged from hospice care. (more…)
CMS Updates MSN for Hospice Services
Authored By: David W. Bufford
The Centers for Medicare & Medicaid Services (CMS) has responded to criticism detailing how Medicare contractors present hospice service charges in the Medicare Summary Notice (MSN) to beneficiaries. In recent years, CMS has added new reporting requirements for visit data on hospice claims. This resulted in an expansion of the information of the claim record to better understand the services provided under the hospice benefit. However, the new data cause confusion for Medicare beneficiaries when they reviewed their MSN.
Effective July 1, 2012, with an implementation date of July 2, 2012, CMS will revise the presentation of hospice cost charges on the MSN. The revised MSN will be similar to the home health MSN and more accurately reflect the claim data.
This change should reduce beneficiary confusion and present the hospice claim data more clearly. Visit-charge descriptions will inform beneficiaries that the hospice service charge is included in the payment for the hospice daily level of care. This will alleviate the perception of some hospice beneficiaries that they will be billed individually for covered services.
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.
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…)
Topical Index
- Home Health (44)
- Hospice (40)
- Litigation and Risk Management (38)
- Long-Term Care (140)
- Medicaid/Medicare enrollment and regulatory compliance (70)