CMS Issues Instructions for PDGM Claims Processing

By:

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 11081, which provides claim processing  instructions to the Medicare Administrative Contractors ( MACs) that will be necessary to process home health claims with the implementation of the Patient Driven Groupings Model (PDGM). The PDGM will assign 30-day periods of care into one of […]

Read More

Hospices: The Time is NOW to Ensure You are Effectively Managing Your Aggregate Cap Responsibilities

By:

  –NAHC Offers Free Webinar to Members to Advance Industry Expertise The National Association for Home Care & Hospice (NAHC) will hold a critical webinar that every hospice provider needs to attend – Mastering Management and Calculation of the Hospice Aggregate CAP. The webinar will take place on Tuesday, February 5, 2019 from 1:00 PM […]

Read More

Hospices: The Time is NOW to Ensure You are Effectively Managing Your Aggregate Cap Responsibilities

By:

NAHC Offers Free Webinar to Members to Advance Industry Expertise The National Association for Home Care & Hospice (NAHC) will hold a critical webinar that every hospice provider needs to attend – Mastering Management and Calculation of the Hospice Aggregate CAP. The webinar will take place on Tuesday, February 5, 2019 from 1:00 PM to […]

Read More

Special Alert for All Home Health Operators!

By:

An extremely serious issue involving Medicare home health has surfaced that requires the immediate attention of your organization. Effective January 13, 2018, the “Plan of Care” (POC) Condition of Participation under 42 CFR 484.60 also became a Condition for Payment under the home health benefit, 42 CFR 409.43. This means that all the elements must […]

Read More

CMS Further Modifies Processes Related to Redesign of Hospice Periods in CWF

By:

Earlier this year the Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters Article (SE 18007 – Recent and Upcoming Improvements in Hospice Billing and Claims Processing) that announced significant changes to the way hospice periods are configured in the Common Working File (CWF).  MLN SE 18007 also announced improvements to the way […]

Read More

CMS Holds Hospice, Home Health “Patients over Paperwork” Listening Sessions at NAHC Conference

By:

–Sessions part of CMS’ expansion of “customer engagement” initiatives Approximately one year ago the Centers for Medicare & Medicaid Services (CMS) announced its “Patients over Paperwork” initiative, under which the agency began in-depth discussions on steps that could be taken to reduce unnecessary regulatory burdens on health care providers, increase efficiencies, and improve the beneficiary […]

Read More

CMS Revises Instructions for Statistical Sampling

By:

The Centers for Medicare & Medicaid Services(CMS) has issued Change Request (CR) 10067 which revises instructions to the CMS medical review contractors (Medicare Administrative Contractors (MACs), the Recovery Audit Contractors (RACs), the Supplemental Medical, Review Contractors (SMRCs), and the Unified Program Integrity Contractors (UPICs)) on the use of statistical sampling for overpayment estimations. The revised […]

Read More

CMS Stipulates Credentials of Medical Reviewers

By:

The Centers for Medicare & Medicaid Services (CMS) released Change Request 10909, which requires that the Medicare medical record review contractors ensure medical review audits are conducted by registered nurses, therapist or physicians. The requirement applies to the Medicare Administrative Contractors (MACs), the Comprehensive error Rate Testing Contractors (CERT), the Recovery Audit Contractors (RACs), the […]

Read More

CMS Issues Instructions for the Misuse of RAPs

By:

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 More

CMS Incorporates Targeted Probe and Educate Guidelines into Medicare Program Integrity Manual

By:

The Centers for Medicare & Medicaid Services (CMS) directed the Medicare Administrative Contractors (MACs) to replace the existing Progressive Corrective Action (PCA) medical review process with Targeted Probe and Educate (TPE) beginning October 1, 2017.  Under TPE, MACs conduct data analysis to identify appropriate areas for review and then identify providers with high claim denial […]

Read More

CMS Issues Further Clarification on Provider MSP Responsibilities

By:

Medicare-participating providers are required to determine whether Medicare is a primary or secondary payer for each admission, start of care or encounter with a beneficiary prior to submitting a bill by asking the beneficiary about any insurance coverage that may be primary to Medicare.   The Centers for Medicare & Medicaid Services (CMS) has a model […]

Read More

Revised Instruction for Correcting a Hospice Revocation Date

By:

The Special Edition MLN Matters article, SE18007, Recent and Upcoming Improvements in Hospice Billing and Claims Processing, included instructions for removing a revocation date when it was submitted entirely in error by submitting type of bill (TOB) 8xB with zeroes in the Through date. The Medicare Administrative Contractors (MACs) are reporting that the Centers for […]

Read More