Archive for 'Breaking News'

Nine Suspects Conspire in $1M Home Health Fraud

Posted on 14. Apr, 2010 by .


Pennsylvania Attorney-General filed the criminal charges based on evidence presented to a grand jury.

Nine suspects have been charged in Monroe County, Pennsylvania with what was dubbed as a “complex disability fraud scheme,” the Pennsylvania Attorney General’s office announced on March 29. (more…)

Continue Reading

Older Women Prefer Home Care

Posted on 07. Apr, 2010 by .

Survey reports why insurance with home care benefit is popular.
More older women get home-based care for chronic health issues than men, a study by the American Association for Long-Term Care Insurance (AALTCI) reveals.

The study showed that about 60 percent of home care recipients were women. Among the same group, over 80 percent were 75 years or older. There were 1,000 men and women respondents to the survey, which was conducted by the association through a one-week period in March. (more…)

Continue Reading

HHS OIG Targets Hospice Overpayments

Posted on 24. Mar, 2010 by .


Hospice claims errors cost Medicare $1.8 billion in 2006, says OIG.

Sure, the title is a real snore, but that doesn’t mean hospice providers shouldn’t wake up and check out the HHS Office of Inspector General’s Compendium of Unimplemented Recommendations for 2010 — especially if you want to steer clear of audits and compliance problems.

The recommendations stem from the OIG’s finding that 82 percent of hospice claims for beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement in 2006, which cost Medicare about $1.8 billion.

“Thirty-three percent of claims did not meet election requirements, and 63 percent did not meet plan-of-care requirements. For 31 percent of claims, hospices provided fewer services than outlined in beneficiaries’ plans of care. In addition, 4 percent of claims did not meet certification of terminal illness requirements,” the report adds. (more…)

Continue Reading

Want an ICD-10 Preview Straight from the Horse’s Mouth?

Posted on 15. Mar, 2010 by .


CMS busts ICD-10 myths in upcoming webinar. And we try some ICD-10 mythbusting ourselves.

If you’ve heard lots of rumors about ICD-10 codes lately, and want to get the real story straight from the horse’s mouth — here’s your chance.

CMS is holding a free webinar on ICD-10 basics on Tuesday, March 23, from 1:00 – 2:30 PM. They plan to dispel common misconceptions about ICD-10 and explain how medical documentation will change with the new codes.

Can’t make the webinar? Written and audio transcripts will be available afterwards on this site.

I don’t know about you, but I just CAN’T WAIT until March 23 to bust some ICD-10 myths. Let’s start mythbusting now! Which of these statements is REALITY, and which ones are MYTH?

1. The number of diagnosis codes available will balloon from 13,500 to 120,000.

2. T.V.’s Dr. House already uses ICD-10 codes.

3. Some organizations that certify coders will require coders to take a separate ICD-10 test in order to keep their credentials.

4. There are free tools available already to help you crosswalk ICD-9 codes to ICD-10 codes.

5. Don’t worry about using ICD-10 codes by October 1, 2013, because CMS always drags deadlines like that out for several years.

6. Coding reference manuals will not exist when ICD-10 comes, because there will be t00 many codes to put in a book.

Curious about the answers? Click here. (more…)

Continue Reading

CMS Eases Up On CHOW 36-Month Rule

Posted on 11. Mar, 2010 by .


Rule still freezes many M&As.

The feds have made good on a pledge to loosen a punishing new restriction on home health agency changes of ownership (CHOWs) — but the new rule will still hit many HHAs hard.

In regulations that took effect Jan. 1, the Centers for Medicare & Medicaid Services puts new restrictions on billing for agencies in certain CHOW situations. When an agency has undergone a CHOW in the last 36 months, a second CHOW will trigger a Medicare billing deactivation that the agency can remedy only with a state or deemed accreditation survey, CMS says in Dec. 18, 2009 Transmittal No. 318 (CR 6750). Once the agency successfully completes the survey, it must send the results to its intermediary, which will reinstate the provider’s billing privileges, the transmittal says.

Due to a wider than usual definition of a CHOW, the change can wreak major havoc on agencies who simply went through minor stock or ownership partner changes.

At the time, CMS said the new rule would apply to any CHOWs in the pipeline. But now it says in an MLN Matters article addition that it will apply the rule only to CMS-855A applications received after Jan. 1. “Applications received prior to January 1, 2010, will be handled in accordance with the policies in place prior to January 1, 2010,” CMS explains in the brief clarification.

The new modification won’t make a difference to many agencies, points out consultant William Cuppett in the National Association for Home Care & Hospice newsletter. “The 36-month rule, as it is now being implemented, will cost Medicare providers substantial amounts of money and resources in their attempts to meet organizational objectives that would best serve their patient populations,” Cuppett warns. “Future transactions may require the incorporation of management agreements or other arrangements facilitating a transfer of control without a transfer of ownership pending completion of the 36-month period from any previous ownership transfer.”

The bottom line: “The current CMS policy position has essentially frozen any changes in ownership, including internal corporate reorganizations, because of the significant risks that exist that Medicare participation may be terminated,” NAHC says.

Resource: Learn more from this CMS MLN Matters article.

© Home Care Connection.

CAHPS basics you need to know.

Continue Reading

Prepare for OASIS C Login Changes on February 23

Posted on 17. Feb, 2010 by .


Sharing an OASIS login identification number with everyone else in your agency will soon be a thing of the past.

Beginning Feb. 23 and ending July 27,the Centers for Medicare & Medicaid Services will be changing the way you log in to the OASIS submission system and CASPER reports,  CMS says. Instead of everyone within an agency using one state-assigned shared agency login identification, each user within the agency will have an individually assigned personal login ID, Erin Harris with CMS contractor Iowa Foundation for Medical Care explained in the Jan. 20 home health Open Door Forum. If you need to use the system to transmit OASIS data or to access or run reports, you will need your own ID. (more…)

Continue Reading

President’s Budget Calls For Billions In Home Care Cuts

Posted on 10. Feb, 2010 by .


Prepare for fraud scrutiny to ramp up under new 2011 proposal.

Comprehensive health care reform may be up in the air, but President Obama expects billions of dollars to be stripped from home health agency spending one way or another.

The president’s 2011 budget proposal released Feb. 1 does not spell out specific Medicare cuts. But it does assume that health care reform such as the bills advanced by Congress in November and December will pass and the included cuts will take place, Obama administration officials are saying.

This is bad news for home care providers … (more…)

Continue Reading

RAC Targets Home Care Topics For Review

Posted on 01. Feb, 2010 by .


We’ve got the links to help you prepare — plus one attorney’s advice for protecting your HHA.

Home health agencies and hospices may not technically be under Recovery Audit Contractor reviews just yet, but current issues that at least one RAC is investigating are already affecting them.

Health Data Insights, the RAC contractor for Region D, posted 66 new approved issues for review in January. Most of them apply to hospitals, but HDI is also approved to review durable medical equipment topics. And two of the new DME issues will affect HHAs and hospices, too.

Issue #1: The Centers for Medicare & Medicaid Services approved “DME while in Hospice” as an issue on Dec. 22, 2009. The RAC will look for DME claims improperly paid for beneficiaries in a hospice stay. This could cause suppliers to come knocking on hospice doors for payment for claims dating as far back as Oct. 1, 2007. (more…)

Continue Reading

Home Care Providers Brace for Tighter HIPAA Enforcement

Posted on 20. Jan, 2010 by .


Transitioning your home health aides to handheld electronic documentation? Read this first.

There’s a health privacy and security brewing that doesn’t appear to have much to do with home care, but there are some big reasons HHAs should take careful notice.

Connecticut Attorney General is the first state prosecutor to harness the HITECH Act’s new enforcement provisions for HIPAA violations. The AG’s office is sueing Health Net for a security breach involving 446,000 Connecticut enrollees. The AG says the plan failed to promptly notify patients about the PHI breach.

At root of the problem is a portable disk drive containing unencrypted data was stolen from Health Net’s corporate office. That too should make home care providers take careful notice. Securing portable electronic devices should be a big priority if you’re one of the increasing number of HHAs using point-of-service, devices, smart phones and handheld devices. (more…)

Continue Reading

Home Care Washington Watch

Posted on 13. Jan, 2010 by .


Tens of billions in home care cuts are working their way through Congress.

Home care providers need to brace for reimbursement woes if Congress finally passes its health care reform package.

After House and Senate passage of their respective reform bills, Congress’ ability to send one approved reform bill to President Obama is looking more likely.

Watch out: To get the legislation to the president’s desk by his State of the Union address next month, Democratic lawmakers are discussing unconventional ways of securing passage of the bill.

Those routes will most likely bypass the usual conference committee that would work out differences between the House and Senate versions of the bill.

Why it matters: While both bills contain tens of billions of dollars in cuts to home health agency and hospice Medicare rates, the Senate bill is friendlier to the industry, observers say. It includes no reimbursement changes for 2010 and 1 percent reductions to the inflation update in 2011-2013, the National Association for Home Care & Hospice notes. (more…)

Continue Reading