Home Health & Hospice

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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Health Integrity Educational Letter Sent to Home Health Agencies in Texas and Oklahoma

Home Health & Hospice /

(November 8, 2013): Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Zone 4. This zone is comprised of Texas, Oklahoma, New Mexico and Colorado. Generally, Health Integrity has been assigned responsibility for handling Medicare Part A, Medicare Part B, and Durable Medical Equipment (DME) claims. Health Integrity has been especially aggressive in

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Home Health Prepayment Reviews are Increasing. Is Your Documentation Compliant?

Home Health & Hospice /

(January 30, 2013): Are the home health services you are currently providing compliant with applicable coverage, documentation and medical necessity requirements? Have you carefully reviewed your current caseload to ensure that each patient does, in fact, qualify as “homebound.” Do you have an effective Compliance Plan in place to assist you with your efforts? Now,

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