Home Health & Hospice

CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States

Home Health & Hospice /

(July 5, 2016) The Centers for Medicare and Medicaid Services (CMS) has announced a home health pre-claim review demonstration project to be initiated in five states. According to CMS, the purpose of the new project is to prevent improper Medicare payments, enhance quality of care, and deter waste, fraud, and abuse in the Medicare program. […]

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Home Health HIPAA Violation Costs $239,800!

Home Health & Hospice /

(March 29, 2016) Lincare, Inc., a provider of respiratory care, infusion therapy and medical equipment to in-home patients, will pay $239,800 in Civil Money Penalties (CMPs) for violating the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule after a HHS Administrative Law Judge (ALJ) ruled in favor of the Office for Civil Rights (OCR).

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Medicare’s Home Health Probe and Educate Program is Underway

Home Health & Hospice /

(December 4, 2015): The Centers for Medicare and Medicaid Services (CMS) has directed its contractors to initiate a home health probe and educate program review process with home health agencies around the country. The focus of this program will be to assess agencies’ compliance with the new face-to-face (F2F) documentation requirements that became effective 01/01/15.

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Are More Home Health Program Integrity Initiatives on the Horizon?

Home Health & Hospice /

(April 22, 2015): Late last month, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released its 2015 “Compendium of Unimplemented Recommendations” (Compendium). Published annually, the Compendium sets out the top 25 program integrity issues previously identified by HHS-OIG that are expected to “most positively impact HHS programs in terms of cost

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CMS Has Clarified the HHA Definition of When a Patient is Confined to Home

Home Health & Hospice /

(August 26, 2014): On August 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 192, clarifying their definition of when a home health patient is considered to be Confined to Home as described in the Medicare Benefit Policy Manual. This clarification more accurately articulates the Homebound definition found in the Social Security

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Physician Accommodations in CMS’s Face-to-Face Encounter Rules

Home Health & Hospice /

(July 21, 2014): As a condition of Medicare payment, the Affordable Care Act (ACA) requires that prior to certifying a patient’s eligibility for the home health benefit, the certifying physician must document that he or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the patient. This requirement ensures that the physician’s order is

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CMS Proposes Changes to Medicare Home Health Benefit Face-to-Face Encounter Requirement

Home Health & Hospice /

(July 18, 2014):The Centers for Medicare & Medicaid Services (CMS) has proposed several changes to the Medicare Home Health Prospective Payment System (HH PPS). Medicare pays Home Health Agencies (HHAs) through the PPS and pays higher rates for services furnished to beneficiaries with greater needs. One of the proposed changes to the HH PPS involves

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Medicare ALJ Appeals of Denied Home Health Claims

Home Health & Hospice /

(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative

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Home Health Face-to-Face Encounters: Is Your Agency Performing it Properly?

Home Health & Hospice /

(February 6, 2014): Before a Medicare beneficiary may be deemed eligible for home health services, a provider must perform a face-to-face encounter with the patient and certify that he or she is eligible for care. More importantly, the certifying physician must properly document this encounter. However, practitioners are commonly finding that their documentation do not

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