MAC
CMS to Start Review Choice Demonstration in Oklahoma
The Centers for Medicare & Medicaid Services (CMS) will be implementing the Review Choice Demonstration (RCD) for Home Health Services in Oklahoma, effective December 1, 2023. CMS has the ability to expand the demonstration to additional states in the Home Health & Hospice Medicare Administrative Contractor (MAC) Jurisdiction M if there is evidence of fraud, waste, or […]
Read MoreHome Health & Hospice MAC “Operation Collaboration” Summit Sessions Now Available Online
Earlier this year, the Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) – National Government Services (NGS), CGS and Palmetto GBA – hosted the 2021 Virtual HHH MAC Collaborative Summit titled, “Operation Collaboration: We are all in this Together”. The Summit was comprised of joint sessions that occurred on September 15 and 17, and […]
Read MoreHospice MAC “Operation Collaboration” Summit Sessions Now Available Online
In mid-September, the Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) – National Government Services (NGS), CGS and Palmetto GBA – hosted the 2021 Virtual HHH MAC Collaborative Summit titled, “Operation Collaboration: We are all in this Together”. The Summit was comprised of joint sessions that occurred on September 15 and 17, and MAC-specific […]
Read MoreCMS to Proceeed with Targeted Probe and Educate
The Centers for Medicare & Medicaid Services (CMS) has decided to continue to proceed with the Targeted Probe and Educate (TPE) medical review, which they resumed on September 1, 2021. (Please see NAHC Report CMS Resumes Targeted Probe & Educate.) Although, the Medicare Administrative Contractors (MACs) have been conducting limited medical review since August 2020, a […]
Read MoreRecovery of Accelerated Payments Began March 30
The Centers for Medicare & Medicaid Services (CMS) has notified providers and suppliers who received COVID-19 Accelerated and Advance Payments (CAAPs) that the Medicare Administrative Contractors (MACs) began recovering those payments as early as March 30, 2021, depending upon the one-year anniversary of when the first payment was received. The CAAP repayment terms provide as […]
Read MoreHospice Reminder: Deadline for Self-reporting of Aggregate Cap is March 1
Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2020 Cap year no later than March 1, 2021. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) timely may result in payment suspension. (Note: the deadline is usually the last day of February but because February […]
Read MoreCMS Directs MAC Outreach to Hospices in MA VBID Demonstration Model Areas
Beginning on January 1, 2021, through the VBID Model, participating Medicare Advantage Organizations (MAOs) can voluntarily participate in the Hospice Benefit Component of the Model, according to a November 13 transmittal (10458/CR 12045) from the Centers for Medicare & Medicaid Services (CMS). During CY2021, nine plans will test coverage of Hospice as part of their […]
Read MoreMedical Review Resumes This Month
The Centers for Medicare & Medicaid Services (CMS) will resume medical revnew this month after originally delaying the program during the COVID-19 public health emergency (PHE). (NAHC Report originally reported this news on July 9.) On March 30, CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic and, seemingly, for the […]
Read MoreCMS Updates Targeted Probe & Educate Information
The Centers for Medicare & Medicaid Services (CMS) published updated targeted probe and educate (TPE) information contained in Chapter 3 of the CMS Program Integrity Manual (Publication 100-08) through Transmittal 10132/Change Request (CR) 11695. The updates incorporate information about TPE practices providers have experienced, but were not clearly outlined in the Manual. This update includes […]
Read MoreProgram Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability
The Centers for Medicare & Medicaid Services (CMS) recently released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft. […]
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