—Via AAHomecare—WASHINGTON, D.C. (August 16, 2017)—Last year, CMS finalized the rule to move forward with expanding the prior authorization (PA) program. Although the program has great support from the industry, AAHomecare expressed concern with the lack of physician involvement in the correspondence of the PA decision. Unlike the PMD Demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision.
CMS
WASHINGTON, D.C. (August 16, 2017)—Last month, CMS published the annual Medicare Fee-For-Service Improper Payments Report. CMS reports that for dates of service between July 2014–June 2015, the error rate for DMEPOS was 46 percent, which is an increase of 7 percent from the previous year. For the report, 10,999 DMEPOS claims were reviewed. However, CMS states that the majority of this rate is attributed to insufficient documentation and not due to medical necessity.
Proposed rule updates geographic areas and mandatory participation requirements.
—Via CMS—WASHINGTON, D.C. (August 15, 2017)—Today, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis.
A past, present and potentially forward look at physician house calls and home health
Meeting and follow-up letter highlighted patient access in non-competitive bid areas.
WASHINGTON, D.C. (August 2, 2017)—AAHomecare’s Kim Brummett and Mina Uehara recently participated in a Government Accounting Office (GAO) interview regarding patient access in non-competitive bid areas and followed up with a letter to the Agency summarizing key points from the session. In discussing the effects on patient access since the 2016 cuts, AAHomecare notes:
Payment rates and wage index were included in the final rule.
—Via CMS, WASHINGTON, D.C. (August 1, 2017)—On August 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1675-F) that updates fiscal year (FY) 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries, and also updates the hospice quality reporting requirements.
The coalition asks CMS to partner with homecare organizations to ensure Medicare beneficiaries are protected.
WASHINGTON, D.C.
Expert review allows changes prior to submission to CMS, reducing audit burden.
ATLANTA (July 17, 2017)—Brightree, a provider of cloud-based patient management software for post-acute care companies, announced the release of OASIS (Outcome and Assessment Information Set) review to its billing and coding suite of services for home health and hospice agencies.
2017 National Health Care Fraud Takedown
The Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, participated in the largest health care fraud takedown in history in July 2017. (Office of Inspector General)
Second quarter registration opening soon.
—Via AAHomecare, WASHINGTON, D.C. (July 13, 2017)—The latest HME Audit Key survey results, running through the first quarter of 2017, show continued appeal determinations in favor of suppliers in several product categories, including overturn rates of 68 percent for respiratory products, 77 percent for ostomy, urological, wound care, and diabetic supplies, and 81 percent for NPWT devices and supplies. Other highlights from this round include:
The webpage works to educate providers in these underserved areas.
—Via CMS, WASHINGTON, D.C. (July 11, 2017)—CMS launched a new Quality Payment Program (QPP) webpage dedicated to doctors and other clinicians working in small or rural practices as well as those treating patients in underserved areas. This page provides:
Rates apply for July 1 through December 31, 2016
WASHINGTON, D.C. (July 7, 2017)—TRICARE is issuing its first official acknowledgements that they will reprocess claims from July 1 through December 31, 2016 to reflect adjustments to the fee schedule mandated by last December’s CURES bill.
HME competitive bid data was not included in the update.
WASHINGTON, D.C. (June 29, 2017)—CMS released proposed 2018 changes to End-Stage Renal Disease (ESRD) Prospective Payment System and related kidney/renal disease regulations.
The June 30 deadline for the Cures Act exemption for Group 3 power products is continued indefinitely.
WASHINGTON, D.C. (June 26, 2017)—The Centers for Medicare & Medicaid Services (CMS) today announced that accessories for Group 3 power Complex Rehab Technology (CRT) mobility products will continue to remain exempt from the application of competitive bidding derived pricing for Medicare beneficiaries.
Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018.
WASHINGTON, D.C. (June 21, 2017)—The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.
FALLS CHURCH, Va. (June 20, 2017)—Evans Incorporated, a provider of human-centered organizational, process, technology and operational consulting solutions focused on fail-safe solutions in health care and aviation announces today that it is hosting an Emergency Preparedness Webinar on Tuesday, June 27, 2017 from 12–1 PM ET to discuss the procedural and regulatory challenges related to health care emergency preparedness.
Data details health care spending for residents by service and major payer.
WASHINGTON, D.C. (June 14, 2017)—The Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014.