MACs
CMS Modifies Calculation of 2022 Hospice Aggregate Cap Year Liabilities
Editor’s Note: Special thanks go to Ted Cuppett, CPA, Director of The Health Group in Morgantown, WV, for permission to reprint the following article. On July 20, 2023, the Centers for Medicare & Medicaid Services (CMS) instructed the Medicare Administrative Contractors (“MACs”) to modify the calculation of hospice CAP liabilities for the 2022 CAP Year. […]
Read MoreHospice Claims Incorrectly Returned to Provider
Some hospices are seeing claims Return to Provider (RTP) due to a problem with the attending physician’s National Provider Identifier (NPI). Transmittal 11633/Change Request (CR) 12889 which instructs MACs to have an edit that validates the attending physician’s NPI includes hospice claims and should not. The CR instructs MACs to validate the NPI in the Attending […]
Read MoreHome Health Quality Reporting Program: Non-Compliance Notifications
The Centers for Medicare & Medicaid Services (CMS) is providing notifications to home health agencies that were determined to be out of compliance with the Home Health Quality Reporting Program (HHQRP) requirements for calendar year (CY) 2021, which will affect their calendar year (CY) 2023 Annual Payment Update (APU). Non-compliance notifications will be distributed by […]
Read MoreQuarterly Credit Balance Reports Due Soon
As a reminder, the Medicare Credit Balance Report for the quarter ending September 30th is due by October 30, 2022. The Centers for Medicare & Medicaid Services (CMS) requires participating providers to furnish information about payments made to them and to refund any monies incorrectly paid in a timely manner. The form CMS-838 is used to […]
Read MoreCMS Revises Manual instruction Related to Misuse with the NOA
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12595 to update various sections within Chapter 4 of the Medicare Program Integrity Manual, including the removal of references to Request for Anticipated Payment (RAP) suppressions. The CR also adds program integrity policies around abuses with the Notice of Admission (NOA). CMS […]
Read MoreFY2022 Hospice Medicare and Medicaid Base Rates at a Glance
Hospice Medicare FY2022 Pricer Now Available Beginning October 1, 2021, hospice base payment rates will increase by two percent, as published in the final FY2022 Hospice Payment Rule. As is customary, the Medicaid program waits until Medicare rates are finalized to issue guidance on the applicable corresponding hospice payment rates. The Medicaid Financial Management Group […]
Read MoreCMS to Resume Provider Enrollment Activities
The Centers for Medicare & Medicaid Services (CMS) has announced the resumption of several provider enrollment activities that have been paused since the beginning of the public health emergency related to the COVID-19 pandemic. Beginning in October 2021, the following activities will be resumed. Application Fees – 42 C.F.R. 424.514 Criminal background checks associated with […]
Read MoreCMS Resumes Targeted Probe & Educate
NAHC urges CMS to suspend TPE until the public health emergency ends The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that it will resume the targeted probe and educate (TPE) program that was suspended in March 2020 (as were most medical reviews) due to the COVID-19 public health […]
Read MoreCMS Issues Instructions for the Misuse of RAPs
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 10789 that adds a new section to the Medicare Program Integrity Manual addressing actions the Medicare Administrative Contractors (MACs) should implement when potential fraud, waste or abuse is identified in relation to home health agency’s misuse of requests for anticipated payments (RAPs). In […]
Read MoreCMS Updates Program Integrity Manual to Clarify MAC Responsibilities Related to Provider/Supplier Revalidation
On December 29, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Change Request 10386/Transmittal 762, which modifies chapter 8 of the Program Integrity Manual to clarify Medicare Administrative Contractor (MAC) requirements for issuing revalidation approval letters and for releasing revalidation status information to callers over the phone. The changes reflected in the transmittal […]
Read More
