The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. The final rule will be published in the April 27th Federal Register, and the rule will become effective 60 days after publication, June 26.
Archive for the ‘Medicaid/Medicare enrollment and regulatory compliance’ Category
CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings
Authored By: David W. Bufford
OIG Publishes Report on Failure of Nursing Homes to Prepare, Respond to Disasters
Authored By: David W. Bufford
The Office of the Inspector General (OIG) just released a report on the failure of nursing facilities to develop and implement adequate emergency preparedness and response programs. The “Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010″ report is the summation of an OIG study to assess emergency preparedness and response during recent disasters. (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.
CMS Reverses Course on Requiring Independent Pharmacy Review
Authored By: David W. Bufford
In a surprise reversal, the Centers for Medicare & Medicaid Services (CMS) has dropped a controversial proposed regulation that would require nursing homes to hire independent pharmacists to oversee residents’ medication regimens.
The proposed rule had been developed in response to the belief that relationships between long-term care providers and pharmacy suppliers could conflict with the best interests of nursing home residents.
In response to overwhelming criticism, CMS has dropped the proposed regulation for now, which they acknowledged would be “highly disruptive to the industry.” Regulators “decided to further study the issue for future policy considerations,” Jonathan Blum, deputy director of the agency, said in a conference call with reporters.
CMS remains concerned about inappropriate medications for nursing home residents, and in a separate statement, encouraged nursing homes to voluntarily adjust how medications are prescribed or face stiffer regulations down the line.
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.
MedPAC Considers SNF Bundled Payments, Therapy Cap Changes
Authored By: David W. Bufford
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional advisory agency that makes formal recommendations to Congress in March and June of each year. MedPAC was created to advise Congress on issues affecting the administration of the Medicare Program. While Congress is not obligated to follow MedPAC’s recommendations, the recommendations are heavily considered.
This month, MedPAC released their semi-annual recommendation which included utilizing bundled payments to skilled nursing facilities (SNFs) and other post-acute providers to encourage more efficient coordination of care, and discourage high volumes of service. Many questions remain about how a budled payment would work, but it is something Congress is considering.
Another issue raised by the MedPAC recommendation was therapy caps. The therapy cap is a Medicare annual limit on the per-beneficiary out-patient therapy services benefit. MedPAC’s data shows therapy costs growing at a faster rate than therapy patients; meaning the therapy cost per patient is growing. MedPAC made recommendations to Congress on ways to stymie the increasing per-patient costs, including requiring stronger “physician attestations” on reimbursement claims, or overhauling the payment system.
Both of these issues still have many details to work out, but providers should be aware that Congress is considering such changes.
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 Expected to Release Guidance on New LSC Adoption Soon
Authored By: David W. Bufford
The 2012 Life Safety Code (LSC) contains numerous provisions that address culture change in nursing facilities. These new provisions are somewhat of a liberalization of standards to permit a more home-like environment for residents, rather than an institutional setting. I am expecting the Centers for Medicare & Medicaid Services (CMS) to release a Survey & Certification Letter (S&C Letter) within the next few days that will permit facilities to adopt these new standards through a waiver process. (more…)
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.
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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.
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 Seeks Savings Through Changes in Medicaid Drug Payments
Authored By: David W. Bufford
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that enacts a provision of the Patient Protection and Affordable Care Act (PPACA) that seeks to make Medicaid reimbursement for medications more transparent and more closely aligned with what pharmacies pay for the drugs. In a press release, CMS states the rule will save states and taxpayers $17.7 billion on prescription drugs over the next five years. The regulations would also increase the rebates paid by drug makers that participate in Medicaid and would establish rebates for drugs provided to enrollees in Medicaid managed-care plans. Comments will be accepted on the proposed rule until April 2, 2012, with a final rule scheduled for 2013.
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.
Administration Recommends Only Two Sections of PPACA be Overturned if SCOTUS Rules Unconstitutional
Authored By: David W. Bufford
The Department of Justice (DOJ) has recommended to the Supreme Court of the United States (SCOTUS) that only the provisions of the Patient Protection and Affordable Care Act (PPACA) that require insurers to accept everyone regardless of health status and to apply “community rates” be overturned if the Justices rule that the law’s mandate is unconstitutional. (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…)
Physician Assistants Now Permitted to Perform SNF-Level Certifications, Recertifications
Authored By: David W. Bufford
This week, the Centers for Medicare & Medicaid Services (CMS) updated Section 40.1 of Publication 100-1, the Medicare General Information, Eligibility and Entitlement Manual, to reflect Section 3108 of the Patient Protection and Affordable Care Act (PPACA). This update permits physician assistants to perform the initial certifications and recertifications of a beneficiary’s need for skilled nursing facility (SNF) level care.
This update’s implementation date is February 13, 2012, and is effective for services furnished on or after January 1, 2011. (more…)
MedPAC Recommends Significant SNF Reimbursement Changes
Authored By: David W. Bufford
The Medicare Payment Advisory Commission (MedPAC) voted on Wednesday of this week to recommend to Congress a significant change in the way skilled nursing facilities (SNFs) are reimbursed under the Medicare program within the next two years. (more…)
For New Cost Report Periods, PPACA Requires Direct Care Expenditure Accounting
Authored By: David W. Bufford
Under the Patient Protection and Affordable Care Act (PPACA), skilled nursing facilities (SNFs) are required to seperately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff). CMS recently posted updates to the Provider Reimbursement Manual detailing the changes, and guidance on completing the new cost report forms. (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 Announces Timeline for Round 2 of Competitive Bidding
Authored By: Kendra Conover
The Centers for Medicare & Medicaid Services (“CMS”) announced yesterday the timeline for Round 2 competitive bidding for Durable Medical Equipment, Prosthetics, Orthotics and Suppliers (“DMEPOS”), with registration set to begin on December 5, 2011.
According to the release from CMS, the 60-day bid window for Round 2 and the National Mail-Order Competition for Diabetic Supplies opens on January 30, 2012 and closes on March 30.
Other important dates include:
• December 22: “Authorized officials” are strongly encouraged to register no later than this.
• January 12: “Backup authorized” officials are strongly encouraged to register no later than this.
• February 9: Registration closes.
• February 28: Document review date for bidders to submit financial documents.
Also posted at the competitive bidding website yesterday were 21 new documents that provide critical information for Round 2. The documents provide information on grandfathering, financial documentation, exemptions, enteral nutrition, capacity and expansion plans, contract supplier obligations, national mail-order competition for diabetic supplies, eligibility requirements, specialty suppliers, subcontracting and other details.
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.
CMS to Host Open Door Forum, Discuss Top SNF Regulatory Issues
Authored By: David W. Bufford
In the next Centers for Medicare & Medicaid Services (CMS) Open Door Forum conference call, CMS will discuss the top regulatory issues skilled nursing providers face. The monthly CMS Open Door Forum provides an opportunity for providers to listen to CMS discuss current topics, as well as participate in a Q&A session. The next Open Door Forum is scheduled for December 1, next Thursday, at 2p.m. EST. The Open Door Forum is free to participate in, and available at 1-800-837-1935, conference I.D. number 93952052.
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.
LTC Providers Must be Aware of EJA Reporting Requirements
Authored By: David W. Bufford
The Elder Justice Act (EJA) was enacted as part of the Patient Protection and Affordable Care Act (PPACA) in March, 2010, and creates a duty for long-term care providers to swiftly report any reasonable suspicion of a crime committed against any individual who is a recipient of care from the facility, or face significant penalties. (more…)
NFPA Releases 2012 LSC
Authored By: David W. Bufford
The National Fire Protection Association (NFPA) has recently released the 2012 Edition of the Life Safety Code (LSC). Currently, the Centers for Medicare & Medicaid Services (CMS) enforces the 2000 Edition of the LSC. The updated LSC includes many changes for health facilities, and addresses cultural changes for nursing homes. For instance, to move a nursing home to more of a home-like setting, certain provisions will allow some seating in corridors, cooking facilities open to the corridor, and gas fireplaces. These additions are intended to improve nursing home design, but are subject to many requirements and restrictions contained in the LSC.
The new LSC provisions for health facilities will not be in effect until CMS and/or the Joint Commission (for facilities subject to accreditation) adopt the new LSC. This process could take 18 months, or longer.
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.
Update to Scope of DMEPOS Claims Editing for Referring/Ordering Provider
Authored By: Kendra Conover
Change Request (CR) 6421 was recently revised to remove chiropractors from the list of providers who may order or refer for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). All other information in the CR remained the same. As you will recall, in CR 6421, the Centers for Medicare & Medicaid Services (CMS) started the expansion of claim editing to meet the Social Security Act requirements for ordering and referring providers. The claim editing is being expanded to verify that the ordering/referring provider on a claim is eligible to order/refer and is enrolled in Medicare and the Provider Enrollment, Chain and Ownership System (PECOS).
The editing expansion is being done in two phases. We are still in Phase 1 of the implementation process, which began on October 5, 2009. Under Phase 1, if the billed service requires an ordering/referring provider and the ordering/referring provider is not on the claim, the claim will not be paid. If the ordering/referring provider is on the claim, it will be verified that the ordering/referring provider is on the national PECOS file. If the ordering/referring provider is not on the national PECOS file, the claim will continue to process.
Once Phase 2 is started, however, Centers for Medicare & Medicaid Services (CMS) will begin to reject claims if the ordering/referring provider does not have a PECOS record. CMS has not yet announced when Phase 2 will begin, but has acknowledged that it will give providers sufficient notice before claims rejections begin.
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.
CMS Retracts Revised Feeding Tube Interpretive Guidelines
Authored By: David W. Bufford
This past September, the Centers for Medicare & Medicaid Services (“CMS”) posted revised interpretive guidelines concerning the use of feeding tubes in nursing homes. In late October, CMS retracted the Survey & Certification Letter detailing the revised changes so they could include instructions that pertain to the Quality Indicator Survey (“QIS”). Further revised interpretive guidelines will be available soon.
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.
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Topical Index
- Home Health (27)
- Hospice (25)
- Litigation and Risk Management (28)
- Long-Term Care (88)
- Medicaid/Medicare enrollment and regulatory compliance (48)