IRS Issues Final Rule on Medical Device Tax

This document contains final regulations that provide guidance on the excise tax imposed on the sale of certain medical devices.  The tax rate is 2.3 percent.  The final rule exempts medical devices that are purchased at retail outlets, via telephone or on the internet.

For more information please utilize the following link

http://www.gpo.gov/fdsys/pkg/FR-2012-12-07/pdf/2012-29628.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

CMS Issues Updates for Corrections and Delayed Entries in Medical Documentation

CMS has issues guidance to MACs, CERT, Recovery Auditors, and ZPIC contractors.  Amendments and corrections must:

1.      Clearly and permanently identify any amendment, correction or delayed entry as such

2.      Clearly indicate the date and author of any amendment, correction or delayed entry

3.      Not delete but instead clearly identify all original content

For more information please utilize the following link

http://www.cms.gov/Regulations-and Guidance/Guidance/Transmittals/Downloads/R442PI.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

CMS Issues Provider Enrollment Application Fee Amount for 2013

The notice announces a $532 calendar year 2013 application fee for institutional providers that are initially enrolling in the Medicare, Medicaid, or Children’s Health Insurance program.  It also applies to institutions revalidating their Medicare, Medicaid, or CHIP enrollment or adding a new Medicare Practice Location.

For more information please utilize the following link

http://www.gpo.gov/fdsys/pkg/FR-2012-11-30/pdf/2012-29003.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

OIG Issues Compendium of Unimplemented Recommendations

The Office of Inspector General issued is Compendium of Unimplemented Recommendations.  It summarizes significant monetary and nonmonetary recommendations that, when implemented, will result in cost savings and / or improvements in program efficiency and effectiveness.  This includes two unimplemented issues for home health agencies, three unimplemented issues for hospices, and an unimplemented issue for Recovery Audit Contractors. 

For more information please utilize the following link

https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2012.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

Office of Civil Rights HIPAA Guidance Page

The Office of Civil Rights has a HIPAA Guidance Page. The page provides guidance about methods and approaches to achieve de-identification in accordance with the Health Insurance Portability and Accountability Act of 1996 Privacy Rule.  It explains and answers questions regarding the two methods that can be used to satisfy the Privacy Rule’s de-identification standard: Expert Determination and Safe Harbor. 

For more information please utilize the following link

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

OIG Releases Semiannual Report to Congress

The report showed expected recoveries of about $6.9 billion which consist of $924 million in audit receivables and $6 billion in investigative receivables. They have also identified $8.5 billion in savings for FY 2012 as a result of legislative, regulatory, or administrative actions. For fiscal year 2012,

3,131 individuals and entities were excluded from participating in health care programs. There were 778 criminal actions against individuals or entities that engaged in crimes against HHS programs and 367 civil actions, which include false claims and unjust-enrichment lawsuits filed in Federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

For more information please utilize the following link

 https://oig.hhs.gov/reports-and-publications/archives/semiannual/2012/fall/sar-f12-fulltext.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

HHS Releases Proposed Incentives for Nondiscriminatory Wellness Programs

This document proposes amendments to regulations, consistent with the healthcare reform bill, regarding nondiscriminatory wellness programs in group health coverage.  These proposed regulations would increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan from 20 percent to 30 percent of the cost of coverage.  They also propose a further increase to maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use.  They also clarify reasonable design of health-contingent wellness programs and the reasonable alternative they must offer in order to avoid prohibited discrimination.  

The full proposed rule can be viewed using the following link:

http://www.gpo.gov/fdsys/pkg/FR-2012-11-26/pdf/2012-28361.pdf

HHS Releases Proposed Standards Related To Essential Health Benefits

Beginning January 1, 2014 the healthcare reform bill will require health insurance companies to maintain a single, statewide pool for all of their individual health plans.  They may actually combine their small employer market group with the individual health plan into a single statewide pool.  This ensures that insurance premium rate increases would be based on the entire risk pool.  This prevents insurance companies from carving up a state to place higher risk people in single groups to achieve higher premiums.  This proposed rule also includes provisions for health insurance companies to develop catastrophic health insurance plans for the individual market for young adults and people who qualify for the catastrophic health insurance plan.

It also provides a list of the 10 categories that must be included in the core package of essential services.  It identifies the four health insurance plan types which are: the bronze plan which covers 60% of the cost, a silver plan that covers 70% of the cost, a gold plan that covers 80% of the cost and a platinum plan that covers 90% of the cost.  It also establishes the maximum out of pocket cost and in network versus out of network coverage.

The full proposed rule can be viewed using the following link:

http://www.gpo.gov/fdsys/pkg/FR-2012-11-26/pdf/2012-28362.pdf

HHS Releases Proposed Healthcare Reform Regulations

Beginning January 1, 2014 it will be illegal for health insurance companies to discriminate against people who have pre-existing conditions.  Insurance companies will be able to vary health insurance premiums based on family size, tobacco use, geography, and by age.  The age variance is based on the 64 year old people paying only three times more than a 21 year old person.  Health insurance companies can no longer use claim history, gender, health status or occupation to increase premiums.

The full proposed rule can be viewed using the following link:

http://www.gpo.gov/fdsys/pkg/FR-2012-11-26/pdf/2012-28428.pdf

CMS Publishes Home Health Wage Index for 2013

CMS published the Home Health Wage index for 2013.  Since the Home Health PPS Rules increase the percentage of cost related to salaries and benefits by 1.453%.  This makes the changes in the wage index more important on payment rates for 2013.  The table below shows the potential impact of the changes in the Home Health Wage index for 2013.

Wage Index Changes FY 2013 Compared to FY 2012	Rural Areas	Urban Areas
Payment Decrease by over 5%	3	22
Payment Decrease between 2% and 5%	9	78
Payment Decrease between 0% and 2%	23	131
Payment Increase between 0% and 2%	12	89
Payment Increase between 2% and 5%	1	52
Payment Increase by over 5%	1	19

Listed below is the link for the Home Health Wage Index for 2013:

http://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html?redirect=/center/hospice.asp

Please click on CMS-1358-F

If you have questions or need additional information please call Richard Dixon at (321) 473-8561.

Hospice Quality Measures Reporting included in Final Medicare Home Health PPS Update for 2013

CMS has announced the publication of the Final PPS Rules and Rates for 2013.  This update includes information on the Hospice Quality Measures Reporting. 

For data collection period 10/1/2012 to 12/31/2012 the data must be submitted by 1/31/2013.  This will impact hospice payments for FY 2014.  The first item will be the National Quality Forum (NQF) - endorsed measure related to pain management (NQF #209).  This data will be gathered at the patient level, but is reported in the aggregate for all patients.  They also must report Participation in a Quality Assessment and Performance Improvement (QAPI) program that includes at least three quality indicators related to patient care.  They are also required to check off from a list, from a list of topics, all patient care topics which they have at least one QAPI indicator.

Beginning January 1, 2013 all quality measures will be reported on an annual basis.  CMS will provide a Hospice Data Submission Form to be completed using a web-based data entry site.

CMS will provide additional information at the CMS website.  Hospices will be required to report on NQF #209. They also must report Participation in a Quality Assessment and Performance Improvement (QAPI) program that includes at least three quality indicators related to patient care. For data collection period 1/1/2013 to 12/31/2013 the data must be submitted by 4/1/2014.  This will impact hospice payments for FY 2015. 

CMS is in the process of developing required measures to include NQF 1634, 1637, 1638, 1639, and 0208.  They are also working on a standardized assessment instrument to be utilized to capture all the data for each patient.  This would be similar to OASIS data set utilized in the home health industry.  This standard data set could be implemented as soon as 2014.  They are also considering future implementation of measures based on an experience of care survey such as the Family Evaluation of Hospice Care Survey (FEHC).  This could be implemented in the year prior to the standard data set or the year after the standard data set.  They specifically stated they would not implement both in the same year.

Listed below is the link for the final rule. 

http://www.gpo.gov/fdsys/pkg/FR-2012-11-08/pdf/2012-26904.pdf  

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

CMS Publishes Final PPS Rules and Rates for Home Health Agencies

CMS published the final Home Health Prospective Payment Rates for 2013 on November 8, 2012. They made some small changes from the proposed rules including reducing the inflation rate from 1.5% to 1.3%. The also changed the Fixed Dollar Loss Ratio from .67 to .45 to increase the Medicare Outlier payment to 2.5%.  The most detailed change relates to the survey and certification areas. Please carefully read this section of the final rules.

Listed below are the basic revised payment rates:

Description	Final Urban Episode Base Rate For 2013	Final Rural Episode Base Rate For 2013
Base Payment Rates (1)	$2,137.73	$2,201.86

(1)     This must be adjusted by wage index and case mix

LUPA Rates	Urban LUPA Base Rate	Rural LUPA Base Rate
Skilled Nursing (2)	$114.35	$117.78
Physical Therapy (2)	$125.03	$128.78
Occupational Therapy (2)	$125.88	$129.66
Speech Pathology (2)	$135.86	$139.94
Medical Social Services (2)	$183.31	$188.81
Home Health Aide (2)	$51.79	$53.34
LUPA Add On (2)	$95.85	$98.73

(2)     This must be adjusted by wage index

Please remember that all of the above payment rates will be reduced by 2 percent for home health agencies that do not submit quality data.

CMS also made a change to the labor and non-labor portion of payment rates:

Labor & Non Labor Portion of Payment Rates	New 2013	Old 2012	Variance
Labor Portion	78.535%	77.082%	1.453%
Non Labor Portion	21.465%	22.918%	(1.453%)

Listed below is the link for the final rule. 

http://www.gpo.gov/fdsys/pkg/FR-2012-11-08/pdf/2012-26904.pdf  

If you have questions or need additional information please call Richard Dixon at (321) 473-8561.

OIG Publishes Work Plan for 2013 Includes Areas of Review for Home Health & Hospice

The Department of Health and Human Services Office of Inspector General has published their Work Plan for 2013.  The plan summarizes new and ongoing reviews and activities that the OIG plans to pursue with respect to Health and Human Services programs and operations during the next fiscal year and beyond.

This OIG Work Plan includes seven specific items for Medicare Certified Home Health Agencies.  It includes two specific items for Medicare Certified Hospices.   This also includes five specific items for other home health services, community home health services, and waiver home health services.

To give a more detail explanation of this rather complicated issue we have created a FREE On-Demand Webinar.  The On-Demand Webinar is available 24 hours per day 7 days a week.

To view the Free On-Demand please utilize the following link:

http://youtu.be/CZEjLTt4mmM

Here We Go Again! The OIG Recommends CMS to Require Surety Bonds for Home Health Agencies

OIG Surety Bonds

Here We Go Again! The OIG Recommends CMS to Require Surety Bonds for Home Health Agencies    The Balanced Budget Act of 1997 established a surety bond requirement for home health agencies. To implement the Balanced Budget Act requirement, CMS promulgated a final rule on January 5, 1998 requiring each home health agency to obtain a surety bond that is the greater of $50,000 or 15 percent of the annual amount paid to the home health agency by Medicare. In 1998 both the House of Representatives and the Senate issued joint resolutions expressing disapproval with CMS's rule. This was never voted upon, but CMS postponed the implementation dates indefinitely. The OIG report showed from 2007 to 2011 CMS has $354,345,843 in uncollected overpayments from home health agencies. They stated if all home health agencies were required to maintain a $50,000 surety bond CMS could have collected an additional $39,103,854. They do not provide any information on the cost to the home health agencies to obtain these $50,000 surety bonds or proposed any adjustments in home health Medicare payments. It looks like another unfunded Medicare mandate. To give a detailed explanation of this rather complicated issue we have created a FREE On-Demand Webinar. The On-Demand Webinar is available 24 hours per day 7 days a week. To view the Free On-Demand please utilize the following link: http://www.youtube.com/watch?v=oB0Ss1jLg1g&feature=plcp

Solving the Puzzle - Las Vegas January 2013

Have you connected on Linked In with us or joined the group, Home Health Care Agencies and Hospices Workshops and Seminars?

http://www.linkedin.com/groups/Home-Health-Care-Agencies-Hospices-3210819?gid=3210819&trk=hb_side_g

Have you liked our Facebook Page, Dixon Healthcare Solutions  Inc.?  https://www.facebook.com/DixonHealthcareSolutionsInc?ref=hl

Look for posted that will link you to a discount for our January 2013 Vegas seminars on these pages, if you register and pay for the seminars by October 31, 2012.

Hope to see you in Vegas

Margaret Dixon

Free On-Demand Webinar on Accountable Care Organizations

We have received many questions concerning Accountable Care Organizations. We have created a Free On-Demand Webinar that you may view 24 hours per day 7 days a week. It covers information concerning Accountable Care Organizations and their impact on the home health industry. The video does not contain CEU's, but it does provide some great information.

To view the Video please use the following link:

YouTube Video

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Our next series of three day seminars will be held at the Monte Carlo Hotel and Casino in Las Vegas, NV in January 2013.

The first will be "Solving the Home Health Puzzle", a comprehensive three day seminar for home health agencies. The dates for the seminar are January 28th to January 30th. The seminar will cover the following topics: Latest Home Health Update including the Final PPS Rules & Rates for 2013; Employment Law & its impact on Home Health; CMS Expectations for OASIS and Coding; Review of ZPIC & RAC Audits latest issues for home health agencies; Medical Documenting Strategies for Home Health; New Wound Care Strategies for Home Health Agencies; The ABC's of Electronic Medical Records, Telemedicine Impact on home health; Review of latest home health billing issues; and SMART Marketing.

The second seminar will be "Solving the Hospice Puzzle", a comprehensive three day seminar for hospices. The dates for the seminar are January 23rd to January 25th. The seminar will cover the following topics: Latest Hospice Update including the Final Rules & Rates for 2013; Employment Law & its impact on Hospice's; New Hospice Quality Reporting Issues; Medical Review Survival Skills; Review of ZPIC & RAC Audits latest issues for Hospice's; New Wound Care Strategies for Hospice's; Documenting Eligibility; The ABC's of Electronic Medical Records, Telemedicine Impact on Hospice; Review of latest Hospice Billing Issues; and SMART Marketing.

  

The third seminar will be "Solving the Outpatient Rehab and CORF Puzzle", a comprehensive three day seminar for Outpatient Rehab's and CORF's. The dates for the seminar are January 23rd to January 25th. The seminar will cover the following topics: Home Health Contract Strategies; Employment Law & its impact on Outpatient Rehab's and CORF's; New Strategies to Control Cost; Medicare Compliant Documentation; MDS 3.0 / RUGs IV - What Therapist Need to Know; Wound Care strategies for Therapist; Multiple Procedure Payment Reduction Policy (MPPR); Review of Latest Rehab and CORF Billing Issues; The ABC's of Electronic Medical Records, Utilizing Old School Technology; and SMART Marketing.

Richard on YouTube about our new On-Demand Seminar

Video of Richard

OIG List 6 Home Health Questionable Billing Practices

Number 1 - HHAs that have a high average of outlier payment amounts per beneficiary. They stated their threshold was above $403 per beneficiary.

Number 2 - HHAs that billed unusually high number of visits per beneficiary. They stated their threshold was above 90 visits per beneficiary.

Number 3 - HHAs that had an unusually high percentage of beneficiaries for who other HHAs billed Medicare. The stated their threshold was 61 percent.

Number 4 - HHAs that had an unusually high numbers of late episodes per beneficiary. They stated the threshold was more than 2 late episodes per beneficiary.

Number 5 - HHAs that billed for unusually high numbers of therapy visits per beneficiary. They stated the threshold was above 23 therapy visits per beneficiary.

Number 6 - HHAs how had unusually high payments per beneficiary. They stated the threshold was $11,652 in payments per beneficiary.

For more information please go to the following link:

LINK

Learn about the New Proposed HH PPS Rules for 2013

Finally an On-Demand Seminar that Reviews the Proposed Home Health Rules and Rates for 2013

Where is your favorite place to be when you go on line? Now you can attend our On Demand seminar from that place or you can view it from your conference room with your staff. This seminar has two nursing and home health administrator CEU's. We know that it can be hard to get away to attend a one day seminar, now you can attend from your office or the comfort of your favorite spot. Presentation Includes: This presentation consists of two one-hour On-Demand Webinars on the Proposed Home Health PPS Rules and Rates for 2013. It covers the new proposed Medicare payment rates for 2013.  It explains the extensive changes in CMS new home health survey rules.  The presentation provides details on the proposed new alternate sanctions which include civil money penalties for home health agencies that are not in compliance with the Medicare COP's.  It reviews the proposed changes in the home health Face-to-Face encounter rules.  The seminar explains changes in the therapy supervision rules.  It will cover the proposed new case mix adjustment changes.  It explains the proposed revision and rebasing of home health market basket data from 2003 to 2010.  The seminar includes new information on OASIS data submission.  It covers updates on the home health CHAPS reporting.  The seminar also covers the changes in the hospice quality reporting rules.   LINK to On Demand Seminar PRICE:   $199  for each Agency with CEUs for one person CEUs for additional people from the same agency can be obtained for $79 each. If you have questions or need additional information please call Richard Dixon at  (321) 473-8561.

Medicare Hospice Rate for 2013

CMS has published the Medicare Hospice Payment Rates for 2013.  This represents a 1.6% increase in payments for FY 2013.  This rate is comprised of a 2.6% market basket increase; less a 0.7% productivity adjustment; less 0.3% additional hospice-specific productivity adjustment to arrive at the 1.6% rate increase.  Listed below are the Medicare Hospice Payment Rates for 2013:

Code	Description	National Rate	Wage Component	Non-Wage Component
0651	Routine Home Care	$153.45	$105.44	$48.01
0652	Continuous Home Care Full Rate = 24 hours of Care Hourly Rate = $37.32	$895.56	$615.34	$280.22
0655	Inpatient Respite Care	$158.72	$85.92	$72.80
0656	General Inpatient Care	$682.59	$436.93	$245.66

(Notes these rates must be adjusted by wage index)

Hospice Cap amount for cap year ending October 31, 2013 = $25,377.01

Listed below is the temporary link for the proposed rule.  This link will change once it is published in the federal register.

http://www.ofr.gov/OFRUpload/OFRData/2012-18336_PI.pdf

If you have questions or need additional information please call Richard Dixon at

(321) 473-8561.

Medicare Home Health PPS Rules and Rates for 2013 July 9

CMS has announced the publication of the Proposed PPS Rules and Rates for 2013. There are numerous changes included in this proposed rule. This update will include a summary of the key items in the proposed rule. We will follow up this email for the next few days with details on some of the areas.

Description	Proposed Rate 2013	Current Rate 2012	Increase	Percent Increase
Urban Agency Base Rate*	$2,141.95	$2,138.52	$3.43	0.16%
Rural Agency Base Rate*	$2,206.21	$2,202.68	$3.53	0.16%

 *This must be adjusted by wage index and case mix

Total PPS rates increase by 1.5 percent for inflation and decrease by 1.32 percent for case mix creep. The proposed rule establishes requirements for unannounced, standard and extended surveys of home health agencies. It provides a number of alternative or intermediate sanctions that could be imposed if the home health agencies were out of compliance with Federal regulations. It provides some additional guidance in physician face-to-face encounters. It also provides some guidance in the therapy measurements and assessments. The rule also provides information on quality measures for Hospice quality Reporting Program and data submission.