Articles and Blogs

payment

Rebasing Has Arrived – CMS Publishes Home Health PPS 2014 Proposed Rule

[07/02/13]

Posted on July 2, 2013 in Long-Term Care, Home Health & Hospice

Written by: Robert W. Markette

On June 27, 2013, CMS released the proposed home health prospective payment rule (the “PPS Rule”) for calendar year 2014.  While refinements to the ICD-9-CM and discussions of ICD-10-CM implementation are of interest, the most notable change to the PPS Rule for 2014 is CMS’s long-awaited proposal for rebasing home health payments.  Once it... READ MORE

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CMS Releases Study of General Inpatient Hospice Care

[05/07/13]

Posted on May 7, 2013 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

Recently, the Centers for Medicare & Medicaid Services (“CMS”) released the results of a study of hospice general inpatient care (“GIP”) based on an analysis of Medicare Part A hospice claims for beneficiaries who received GIP in 2011.  The intent was to identify suspected abuse of GIP in hospice inpatient facilities by hospice providers because... READ MORE

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Details on Bundled Payment Models

[02/01/13]

Posted on February 1, 2013 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. The Centers for Medicare & Medicaid Services (CMS) hopes these models may lead to higher quality and more coordinated care at a lower cost to Medicare.   READ MORE

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White House to Reach Sequestration Decision Within 30 Days

[08/09/12]

Posted on August 9, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The 2% across-the-board cut in reimbursement for Medicare providers, the result of last summer’s “Super Committee” failure, is scheduled to take place January 1, 2013.  The President recently signed legislation requiring a report detailing how the sequestration process will affect Medicare providers.  Skilled nursing facilities (SNFs) have already seen significant cuts to reimbursement; an... READ MORE

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CMS Releases Hospice Wage Index for FY 2013

[07/24/12]

Posted on July 24, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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... READ MORE

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CMS Postpones Two Anti-Fraud Initiatives

[02/06/12]

Posted on February 6, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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.   READ MORE

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CMS Now Requires EFT Payment for All Providers and Suppliers After Revalidation

[11/09/11]

Posted on November 9, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

Current regulations (42 C.F.R 424.510(e)(1),(2)) require providers and suppliers to agree to receive Medicare payments via Electronic Funds Transfer (“EFT”) at the time of enrollment, revalidation, change of Medicare contractors or submission of an enrollment change request.  Additionally, the provider or supplier must submit a CMS-588 form to receive Medicare payment via EFT.  Section 1104... READ MORE

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DMEPOS Competitive Bidding Round 2 is Coming Soon

[11/02/11]

Posted on November 2, 2011 in Long-Term Care, Home Health & Hospice

Written 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... READ MORE

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2012 Medicare Home Health Payment Changes

[11/02/11]

Posted on November 2, 2011 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

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... READ MORE

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Hospice Owner Indicted for $14.3 Million in False Claims

[10/14/11]

Posted on October 14, 2011 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million.  According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who... READ MORE

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