A registered Republican, Verma’s work favors a conservative agenda. While her vast experience is reassuring, it’s also become a source of controversy.
Special circumstances permit home health agencies and hospice agencies to bill OPPS. This type of billing is relatively unused in home health and can add significant income to agencies willing to explore this path.
Effective January 1, 2017, the Centers for Medicare and Medicaid Services are changing the way negative pressure wound therapy using a disposable device are billed. The coverage of both the service and the device will be shifting from the Home Health Prospective Payment System to the Medicare Hospital Outpatient Prospective Payment System (OPPS).
Prior to the change in 2017, home health outlier payments have been calculated based on large quantities of completed visits within an episode that increase the cost of care past the projected amount for that episode's particular HHRG.
In 2015 the home health improper payments had reached 59% primarily due to unsupported medical necessity. Implementing pre-claim reviews will allow CMS to identify and reject claims in advance for patients who do not meet the home health eligibility criteria, and to understand how to prevent improper payments in the future.
Since hospitals are now financially penalized for re-hospitalizations, the pressure on home health care agencies in the prevention effort has soared; and rightfully so. Home health is the next logical step after a hospitalization for a geriatric patient. It’s only a matter of time before CMS extends the financial implications of re-admissions to the home health and hospice sector.
The Home Health and Hospice industry is set for many changes over the next few years. Growth in demand, increased regulatory oversight regarding billing practices, mandatory annual probes and incentives for quality performance all come together to create an unfamiliar landscape compared to what’s happening today.
CMS intends to create prior authorization processes similar to those currently in use by private insurance companies. Further, CMS will determine the risk of fraud, waste and abuse based on the home health agency’s previous billing patterns.
HIPAA (Health Insurance Portability and Accountability Act of 1996) addresses the protection of individually identifiable health information. Everyone in healthcare is familiar with HIPAA and the general precautions taken to be "HIPAA Compliant" but few really understand the full scope of the legislation.
Home health care agencies will compete against the aggregate of agencies in the country for payment incentives based on quality indicators.
Home health agencies are paid under the Home Health Prospective Payment System which uses a complex model to calculate episodic payment for up to 60 days of skilled home care services.
Originally intended for hospice claims, CMS’ decision to replace the commonly used G0154 is due to the need of a higher level of care during the last days of a patient’s life.
Unlike managed care organizations, CMS leaves it up to the provider to determine the amount and type of services necessary for appropriate rehabilitation. Of course such a laissez faire approach to healthcare comes with a hefty price tag, and a side of fraud. The solution is a plethora of organizations, called Medical Review Contractors, ready to audit and recoup funds at the drop of a dime.
Disaster planning is an integral part of any survey preparation process, and maintenance of the plan can be the difference of many deficiencies. The Joint Commission, for example, devotes an entire chapter of their Home Health Accreditation Program to properly preparing for a crisis.
How do you market a business standardized by law to a person who doesn't gain anything from working with you?
After reaching the October 1'st deadline, were you prepared enough for the transition from ICD-9 to ICD-10?
At FasterNotes, we believe that business should be easy, which is why we’ve compiled a list of important steps to ensure that you are registered properly for claims submissions and all the miscellaneous processes required by Medicare.
On July 30, 1965 President Lyndon Johnson signed Medicare and Medicaid into law. Today, US healthcare is a complicated mega system consisting of multi layered government organizations.
Although every home care agency tries to prepare for surveys, the preparation usually doesn’t involve an exact plan of action when the inevitable day occurs. This lack of preparation results in the agency loosing valuable time in getting all their ducks in a row.
It’s important that HR managers at home health, hospice and private duty agencies understand the rules and the exceptions to those rules to maintain compliant charts that can pass a survey without deficiencies.