Articles and Blogs

MAC

OIG Publishes 2013 Work Plan

[10/05/12]

Posted on October 5, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Office of the Inspector General (OIG) has published their annual Work Plan for 2013. The Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The Work Plan specifically targets skilled nursing facilities (SNFs), hospices, and home health agencies (HHAs). For all types of... READ MORE

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Home Health Agencies’ Claims for Ordered/Referred Services Must be Billed Using Individual Physician’s Name and NPI

[07/24/12]

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

Written by: Selby, Todd J.

In the near future, Regional Home Health Intermediaries (RHHIs) and Parts A and B Medicare Administrative Contractors (A/B MACs) will be contacting home health agencies (HHAs) that have previously submitted claims for ordered or referred services using a group name and national provider identifier (NPI).  HHAs will be informed they should begin submitting such... READ MORE

Tags: , , , , , , , , , , , ,

CMS Revises Initial Certification Process for HHAs

[01/05/12]

Posted on January 5, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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).   READ MORE

Tags: , , , , , , , , , , , , , , , , , , , , ,

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

Tags: , , , , , , , , , , , , , , , , , , , , ,

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

[08/23/11]

Posted on August 23, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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:   READ MORE

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , ,

What Risk Categories Mean to Providers and Suppliers

[08/13/11]

Posted on August 13, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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... READ MORE

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

[08/10/11]

Posted on August 10, 2011 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

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... READ MORE

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

OIG: Expand Oversight and Reduce Incentives to Hospices Focusing on Nursing Facility Residents

[07/22/11]

Posted on July 22, 2011 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

Recently, the Office of Inspector General (“OIG”) published a report of its findings pertaining to the nearly 70% growth of Medicare spending for hospice care provided to nursing facility (“NF”) residents from 2005 – 2009.  During that time, Medicare spending on hospice care for residents in NFs increased sixty-nine percent (69%) from $2.55 billion to... READ MORE

Tags: , , , , , , ,