Time is Running out for Home Health Agencies

Time is running out to register for our latest home health seminar!

Stepping Up For Home Health

February 3^rd to 5^th, 2014

Monte Carlo Hotel & Casino

Las Vegas, NV

The Hotel Will Release Room Block on January 6, 2014

Are you ready for ICD-10?  Do you understand the State of OASIS and Coding Now and in 2014?  Have you developed an approach to Financial Management to improve your operations?  Are you ready to prepare proper documentation to obtain Medicare payments for your patients?  Do you have a plan to respond to audits by RACs or ZPICs?  Has your agency prepared for the Medicare reimbursement changes for 2014?   Do you understand how to work with Accountable Care Organizations?  Are you ready to lead your agency through the various changes?  Have you developed a plan to grow your home health agency?  Do you understand how Developing Your Inner Game can lead you to success?  Have you implemented all the changes required by the HIPPA/HITECH Act?

Merry Christmas

From Our Home to Yours

Merry Christmas Wishing you health and happiness this Holiday Season and prosperity in the New Year. Dixon Healthcare Solutions, Inc. We wish you a Merry Christmas and hope that you will be able to spend time with Family and Friends. Richard and Margaret Dixon wish to thank you for making our year great. Our year has included: Seminars in Vegas January 2013 Preparation of many Cost Reports Seminars on the Big Island of Hawaii Webinar in December on PPS Final Rules for 2014

Link to the Final Rule - CMS Publishes Home Health Final Payment Rate in Federal Register for 2014

CMS Publishes Home Health Final Payment Rate in Federal Register for 2014

CMS has published the Final Rule for Home Health Prospective Payment System update for 2014. It will impact home health payments for the next four years.  The current year impact will reduce home health payments by 1.05 percent or $200 million, but the future impact will be much worse.

Urban Episode Base Rate       $2,869.27

Rural Episode Base Rate         $2,955.15

The above rates include a 34.64% increase in base rate for case mix, but the case mixes are also reduced by percent adjusted in case mix.  Remember the case mix rates are reduced by 34.64%.  The real rates without the impact of adjusting the case mix rates are a reduction of $28.76 or 1.34%.

LUPA Rates     Urban Episodes          Rural Episodes

SN                    $121.10                       $124.73

PT                    $132.40                       $136.37

OT                   $133.30                       $137.30

SP                    $143.88                       $148.20

MSW               $194.12                       $199.94

HHA                   $54.84                         $56.49

Remember all base episode payment rates and LUPA rates must be adjusted for wage index and all rates will be reduced by 2 percent for home health agencies that do not report quality data.

Your episode rates will be reduced by $80.95 for rebasing in 2015, 2016 and 2017.  You will also have a reduction inflation factor adjustment of 1% in 2015, 2016, and 2017.

We will be presenting the “2014 Home Health PPS Final Rule – 2014 in a Webinar” on Wednesday December 4^th from 3:00 to 4:00 PM EST.   It will cover the CMS Rebasing of Home Health Payments, Home Health Episode Payment Rates, LUPA Payment Rates, Medical Supply payment Rates, Changes in Home Health Agency Case Mix, Home Health Wage Index, the 170 Codes Removed from the Home Health PPS Grouper, and Changes in Home Health Quality Reporting.  Richard Dixon will be present the Webinar Live, but you can also review the webinar at a later time because it will be recorded.  The registration fee is only $149 for your entire company.  The fee includes handout you will receive via email.  For more information please go to www.dixonhsi.com and click on the PPS 2014 Webinar.

The link to the final rule is listed below

http://www.gpo.gov/fdsys/pkg/FR-2013-12-02/pdf/2013-28457.pdf

CMS Publishes Home Health Final Payment Rate for 2014

CMS has published the Final Rule for Home Health Prospective Payment System update for 2014. It will impact home health payments for the next four years.  The current year impact will reduce home health payments by 1.5 percent or $290 million, but the future impact will be much worse.

There are many moving parts to this rule.  We will cover some of the basics in this update, but will follow it with other updates this week to provide more detailed information.  Below is a brief analysis of the episode rate.  To provide a better comparison we have one column with the new adjustment for episode case mix standardization and another column without the case mix standardization. (Episode standardization will move the average episode case mix weight from 1.3464 to 1.0000 by reducing all case mix weights by 34.64 %.)

Description	With Case Mix Adjustment	Without Case Mix Adjustment
2012 National Standardized 60 Day Episode Rate	$2,138.52	$2,138.52
Inflate Case Mix Adjustment (x1.3464)	$2,879.30	$2,138.52
Reduce for Nominal Case Mix Growth 2013 (x.9868)	$2,841.29	$2,110.29
Payment Update Percentage for 2013 (x1.013)	$2,878.23	$2,137.72
Outlier Adjustment (Divide by .975)	$2,952.03	$2,192.53
Outlier Adjustment (x .975)	$2,878.23	$2,137.72
Standardization Factor (x1.0026)	$2,885.71	$2,143.28
Rebasing Adjustment 2014 (Remove $80.95)	$2,804.76	$2,062.33
2014 Market Basket Adjustment (x1.023)	$2,869.27	$2,109.76

Our Calculation of Real Decrease Percentage in Home Health Episode Payment Rates

Description	With Case Mix Adjustment	Without Case Mix Adjustment
2012 National Standardized 60 Day Episode Rate	$2,138.52	$2,138.52
2014 Market Basket Adjustment (x1.023)	$2,869.27	$2,109.76
Decrease	N/A	$28.76
Percent Decrease	N/A	1.34%

Remember your episode case mix rates will be decreased by 34.64% so for example C1F1 with 0 to 5 therapy visits will go from 0.8186 case mix rates in 2013 to 0.6080 in 2014.  There are positive adjustment to LUPA payment rates and negative adjustments to Non Routine Medical Supplies. 

Your episode rates will be reduced by $80.95 for rebasing in 2015, 2016 and 2017.  You will also have a reduction inflation factor adjustment of 1% in 2015, 2016, and 2017.

We sent a Newsletter in the summer titled “It is Time to Step Up or Fall Behind”.  We stated that your home health agency is currently going up the down escalator.  The current momentum of the health care industry is constantly pushing your company down, just like a down escalator is constantly moving down.  To step up to the next stair, you adapt and embrace the changes or place your head in the sand and move further down the escalator. 

If you would like to step up instead of falling behind register for our webinar titled “Home Health PPS Final Rule 2014”.  This will be held live on Wednesday December 4, 2014 at 3:00 – 4:00 PM EST.  It will cover the following items:

1.      CMS Rebasing of Home Health Payments

2.      The Home Health Episode Payment Rates

3.      The LUPA Payment Rates

4.      Medical Supply Payment Rates

5.      The Home Health Agency Case Mix Changes

6.      The Home Health Wage Index

7.      The 170 Codes Removed from the Home Health PPS Grouper

8.      Changes in Home Health Quality Reporting Requirements

Richard Dixon will be the presenter of this webinar.  You will have the opportunity to ask individual questions and obtain the answers.  To keep the webinar on time we will address you questions and answers via email after the event.

The webinar will be held live, but you can also review the Webinar at a later time because it will be recorded.  Your registration fee is only $149 for your entire company.  The registration fee also will include handouts that you will receive via email.  

http://www.dixonhsi.com/PPS%202014%20Home%20Health%20Final%20Rule%20Webinar.pdf

To attend the exciting new webinar follow the link below for the Registration Form and fax it back to us at (888) 577-6932.  We have a very short time frame to register attendees so we request you not use the mail.  We do accept all major credit cards.  Once you register you will not be able to cancel since you or any of your employees can view the recording of the webinar at your leisure. 

For more information use the temporary link below (The final link will be available on December 2, 2013 when proposed rule is published in the Federal Register):

https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-28457.pdf

Inpatient Hospital Billing for Hospice Patients

This change request instructs the CWF and FISS maintainers to deny an inpatient hospital claim when the principal diagnosis on the inpatient claim matches one of the hospice diagnosis codes. Services related to a hospice terminal diagnosis provided during a hospice period are included in the hospice payment and are not paid separately. An inpatient hospital claim will be denied when provider’s bill with a condition code 07 on an inpatient claim and the principal diagnosis on the inpatient claim is found to match one of the hospice diagnosis codes.

This change was identified by the CMS Recovery Audit Contractors when they were reviewing payments for inpatient hospital claims related to hospice patients.  The payments associated with these claims are considered overpayments because the Centers for Medicare & Medicaid Services do not pay separately for an inpatient hospital stay when a hospice terminal diagnosis is listed as a principal diagnosis.  The effective date of this notice is April 1, 2014, but beware that some of the RACs and ZPICs may go back to review previous years and deny claims.

For more information please use the following link:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1312OTN.pdf

CMS Turn on PECOS Edits in January

A Christmas gift you do not want, need and cannot return.  CMS is providing bag of coal for home health agencies and other Medicare providers & suppliers by turning on the PECOS Edits on January 6, 2014.  CMS is instructing the Medicare Administrative Contractors (MACs) to turn on Phase 2 of the denial edits.  These edits will check claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid.  This will impact Home Health Agencies, DME, clinical laboratories, and imaging procedures.

For more information please use the following link:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf

Claims Processing Issue Causing Overpayments

CGS (a Medicare Administrative Contractor) has identified a claims processing issue that results in an overpayment displayed on your remittance advice (RA). In these cases, the overpayment amount is reflected either in the adjustment to balance field on the standard paper RA or as adjustment reason code 90 on the electronic remittance advice (ERA). CGS is awaiting further direction from the Centers for Medicare & Medicaid Services (CMS) regarding collection of these overpayments. Providers are encouraged to track the dollar amount associated with the overpayment and the RA/ERA paid date, as CGS anticipates a future recoupment may occur. We do not recommend providers reporting this overpayment on their credit balance report. Please monitor future CGS listservs for additional updates on this issue.

For more information please use the following link:

http://www.cgsmedicare.com/hhh/pubs/news/2013/1013/cope23696.html

Widespread Length of Stay Hospice Edits

Each quarter, the CGS Medical Review Department evaluates all current edits to ensure they continue to be effective in selecting the most vulnerable claims, and that resources are used effectively. In evaluating all our widespread edits, we identified edit 5048T, which selects hospice claims with a length of stay of 999 days or more, has shown a significant decrease in error rates. However, analysis of the length of stay among hospice claims for certain states within CGS jurisdiction is still an issue. Additionally, a 2013 report from the Center for Medicare and Medicaid Services (CMS) titled "Medicare Spending Variation: Our Shared Challenge" indicated several states had a higher hospice spending per beneficiary derived from 2012 data. In an effort to identify claims before they become an issue due to length of stay, CGS will be implementing a new widespread edit that will select claims with a length of stay between 150 days and 365 days for providers that bill to CGS within the states of NH, ID, GA, UT, CO, DE, MO, AL, AR, KS, TS, and WV. Widespread edit 5048T will be discontinued once this new edit 5118T is implemented.

In addition, widespread edit 5091T selects claims when the beneficiary resides in a nursing home, the hospice length of stay is greater than 180 days, and the principal diagnosis is debility, unspecified. Last quarter, this edit had the highest denial rate of all four widespread hospice edits at 61%. The top denial reason for this edit continues to be 5PTER, six-month terminal prognosis not supported.

Due to this edit's on-going error rate and based on clarifications made by the CMS in the Fiscal Year 2014 Hospice Final Rule in regards to principal diagnosis coding, the parameters for edit 5091T will be expanded to include any non-oncologic diagnosis code.

Medical records should contain enough clinical factors and descriptive notes to show the illness is terminal and progressing in a manner that a physician would reasonably have concluded that the beneficiary's life expectancy is six months or less. The top denial reason, 5PTER, is related to the common obstacle of documenting a six-month terminal prognosis. The CMS Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, states an individual is eligible for the Medicare hospice benefit when that individual has a terminal illness with a life expectancy of six months or less if the terminal illness runs its normal course. Documentation is essential for patients that have remained on the hospice benefit for an extended length of time, or for patients that have chronic illnesses or general decline. These diagnoses alone may not support a six-month or less life expectancy; therefore, documentation is depended upon to show why the patient is hospice appropriate. The patient's appropriateness for the hospice benefit must be clearly supported in the medical record from admission and throughout the hospice care provided. To assist providers in improving their documentation, a quick resource tool, "Suggestions for Improved Documentation to Support Medicare Hospice Services" is available on the CGS website.

Suggestion for Improved Documentation to Support Medicare Hospice Services Link:

http://www.cgsmedicare.com/hhh/education/materials/pdf/Hospice%20Documentation%20Tool_H-021-01_07-2011.pdf

CERT Documentation Submission Update

Effective for all initial documentation request letters sent on or after January 1, 2014, providers and suppliers will have 60 days to submit medical documentation in response to initial documentation request for claims selected by the Comprehensive Error Rate Testing (CERT) program.  If no documentation is received by the 60^th day, the claim will be considered a “no documentation” error and recoupment will be pursued.  This information was sent by CGS a Medicare Administrative Contractor.

We have always recommended that you submit your documentation as soon as possible and send it by certified mail return receipt.  We also recommend you send each patient separately and identify on the green return receipt card a patient number.  Do not use patient names or Medicare numbers.  This proves that the record for that medical record number was indeed received.  There have been many cases when documentation was sent timely, but not properly credited as received.

For more information please use the following link:

http://www.cgsmedicare.com/articles/COPE23661.html

CMS Delay’s Issuing Final PPS Home Health PPS Rule

CMS is blaming the partial government shutdown as the reason for delaying the issuance of the Final Home Health PPS Rule for 2014. The final rules should have been issued on by November 2, 2013. They claim they will issues the final rules on or before November 27, 2013.  The Final Home Health PPS Rules will go into effect on January 1, 2014.

Home health agencies patients admitted on or after November 3^rd (who have a full 60 day episode) will be impacted by these final payment rules.  You will not know your actual reimbursement rate until after the final rule is published for these episodes.  The proposed rules reduces your net episode payments by an average of 1.5%, change case mix codes, and eliminate 170 diagnoses from the case-mix codes.  I guess we will all be flying by the seat of your pants for a few weeks. 

We will provide more information when it becomes available

For more information please use the following link:

http://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html

CMS Clarifies “Confined to the Home” Definition

On October 18, 2013 CMS issued Change Request # CR 8444 to clarify the definition of “Confined to the Home”.  CR8444 clarifies the definition of the patient being "confined to the home" to more accurately reflect the definition as articulated at Section 1835(a) of the Social Security Act (the Act). In addition, the Centers for Medicare & Medicaid Services (CMS) removed vague terms, such as "generally speaking", to ensure the definition is clear and specific.

In the Calendar Year (CY) 2012 Home Health (HH) Prospective Payment System (PPS) proposed rule published on July 12, 2011, CMS proposed their intent to provide clarification to the Benefit Policy Manual language regarding the definition of "confined to the home". In the CY 2012 HH PPS final rule published on November 4, 2011 (FR 76 68599-68600), CMS finalized that proposal. In order to clarify the definition, CMS is amending its policy manual as follows:

For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:

Criteria-One:

The patient must either: Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and of residence:  OR Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.

Criteria-Two: 

There must exist a normal inability to leave home: AND Leaving home must require a considerable and taxing effort.

This policy becomes effective on November 19, 2013.  For more information please view the CMS MLN Matters Link and Medicare Benefit Policy Link below:

CMS MLN Matters Link

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8444.pdf

Pub 100-02 Medicare Benefit Policy Transmittal 172 Link

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R172BP.pdf

CMS Adds Another Medical Review Contractor

The Centers for Medicare & Medicaid Services (CMS) has contracted with Strategic Health Solutions, LLC, a Supplemental Medical Review/Specialty Contractor (SMRC) to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs.

One of the primary tasks will be conducting nationwide medical review as directed by CMS. The medical review will be performed on Part A, Part B, and DME providers and suppliers. Services/Provider Specialties to be reviewed will be selected by CMS, Provider Compliance Group/Division of Medical Review and Education (DMRE).  The SMRC will evaluate medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices.

The focus of the reviews may include, but is not limited to vulnerabilities identified by CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and Federal oversight agencies.

Robert Liles has published a good article regarding Strategic Health Solutions.  He will be speaking in February at our Stepping Up For Home Health and Stepping Up For Hospice on the topic of “Preparing and Responding to an Audit by RACs or ZPICs”.  I am sure he will also cover this new audit contractor.  We have listed a link below to Robert’s article.

CMS Link

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/SMRC.html

Robert Liles Article Link

http://www.lilesparker.com/2013/05/09/strategic-health-solutions-2/

Is America Waking Up To Medicare Advantage Plan Pitfalls?

America’s seniors are constantly bombarded by insurance company’s selling Medicare Advantage Plans to replace their current Medicare coverage.  These plans offer lower copayments and more services like free health club memberships.  Most of our senior’s live on a fixed income.  Their income has not kept up with real inflation.  The older and sicker Medicare beneficiaries spend a much higher percent of their income on health care.  This has attracted approximately 12.7 million Medicare beneficiaries to switch to Medicare Advantage Plans.  One study estimated the Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012. 

It appears some of the people have finally noticed the problems with Medicare Advantage Plans.  The Attorney General for the state of Minnesota is asking the federal government to investigate Humana for denying legitimate claims.  They have been accused of pattern of denying claims and overcharging enrollees.  The Attorney General’s office compiled several hundred pages of affidavits that it presented to the federal government on Friday.  This proves Humana has been improperly handling insurance claims by dozens of Minnesotan enrolled in it's Medicare Advantage plans.

A United Healthcare Medicare Advantage plan that covers 35,000 beneficiaries in southwest Florida is dropping at least 300 doctors and hard-to-find medical specialists from its Southwest Florida network.  This will create problems for the beneficiaries to find physicians and healthcare providers. 

Home Health and Hospice providers have long known the problems of dealing with Medicare Advantage insurance companies.  They may require prior approval for services, limit the amount of services for seniors, delay payments, pay lower rates or require home health agencies and hospices to be members of their network. 

Home health agencies, hospices, other providers, suppliers and physicians should become advocates for their Medicare patients.  They should explain the limitations that will be imposed by Medicare Advantage Plans. They should join with other senior organizations and advocate for their patients.  We all need to pull together to stop this exploitation of our seniors. 

Medicare Advantage Plan Study Link

http://www.pnhp.org/news/2013/may/Private-insurers-Medicare-Advantage-plans-cost-Medicare-an-extra-$34.1-billion-in-2012

Minnesota Attorney General Article Link

http://kstp.com/article/stories/s3195872.shtml

United Healthcare Article Link

http://www.news-press.com/article/20131018/HEALTH/310180009/United-Healthcare-drops-300-Southwest-Florida-doctors?nclick_check=1

Medicare Amount in Controversy Threshold Amounts Calendar 2014

The Medicare program requires a claim to have a certain dollar value that exceeds the Medicare amount in controversy to allow the provider or the beneficiary to appeal a claim.  The amount in controversy threshold for calendar year 2014 will be $140 to appeal Medicare claims in all appeal levels up to and including Administrative Law Judge Hearing.  The amount in controversy threshold for calendar year 2014 to take an appeal beyond Administrative Law Judge Hearing to Federal District Court will be $1,430.

OIG Reports on Timeliness of First Level Appeals

On October 13, 2013 the Office of Inspector General (OIG) issued a report on “The First Levels of the Medical Appeals Processes, 2008-2012: Volume, Outcomes, and Timeliness”.  The process focused on redeterminations process for Medicare Parts A and B during 2008-2012.  The surveyed 18 contractors that process redetermination for Medicare Parts A and B and interviewed 5 of them to learn more about how they process redeterminations.

They found in 2012 contractors processed 2.9 million redeterminations, which involved 3.7 million claims, and increase of 33 percent since 2008.  80% of all determination in 2012 involved Part B services, but appeals involving Part A services has risen more rapidly.  In 2012 appeals involving recovery audit contractors accounted for 39 percent of all Part A claims.  Contractors decided in favor of Part A appellants at a lower rate than that for Part B appellants. The contractors largely met the required timeframes for processing redeterminations and paying appeals decided in favor of appellants, but fell short of meeting timeframes for transferring case files for second-levels appeals.

The OIG recommends (1) CMS utilized the Medicare Appeals System (MAS) to monitor contractor performance, (2) continue to foster information sharing among Medicare contractors, and (3) monitor the quality of redetermination data in MAS.

For more information please utilize the following link:

http://oig.hhs.gov/oei/reports/oei-01-12-00150.pdf

Limit of 2 Episodes per Beneficiary per Year In House Bill H.R. 3245

If things were not tough enough on the home health industry (constant Medicare payment cuts, over reaching regulations face-to-face, HIPAA, RACs, ZPICs just to name a few)  H.R. 3245 bill has been proposed, titled “Medicare Home Health Fraud Reduction Act”.  Certainly the home health industry wants to eliminate fraud in home health.  But a bill to limit the home health episodes to 2 per beneficiary per year is ludicrous.   A Medicare Beneficiary’s episodes should be limited based on the need of the patient, not some arbitrary limit proposed by a group who definitely does not fully understand the home health industry. 

I guess we could go into a tirade detailing all the problems in the US House of Representatives and the US Senate.  They cannot pass a budget, live by budgets they pass, they exempt themselves from any laws that they enact, or even speak to each other.  It does not matter which party. They are all an abysmal failure.  America deserves better, but until the next election, I recommend you contact your US House Representative and explain that this is not the way to reduce Medicare Fraud.  What will happen to these Medicare beneficiaries when they cannot obtain their needed home health?  They will either be readmitted to the hospital, forced into a nursing home, or just pass away. 

You are not just advocated for your industry, you are an advocate for the millions of United States citizens who have paid into a system of Medicare that is supposed to provide their health care.  Our seniors are constantly being misled, over promised, targets of deception, and abused.  When I think of our senior citizens I constantly think of the quote of the late Andy Rooney “the best classroom in the world is at the feet of an elderly person”.  Our senior citizens need your help.  Let’s all call our Congress person and stop this insanity.

It is time to get on our Soap Boxes for our Seniors.

To view the actual proposed bill utilize the following link:

http://www.gpo.gov/fdsys/pkg/BILLS-113hr3245ih/pdf/BILLS-113hr3245ih.pdf

Hospice’s Must Furnish Vaccines

On May 3^rd 2013 CMS issued Transmittal 1217.  This update states that a hospice can provide vaccines (Influenza, Pneumococcal, and Hepatitis B vaccines) to those beneficiaries who request them, including those who have elected the hospice benefit.  These services are only covered when provided to hospice beneficiaries by their hospice provider.  This Change Request (CR) updates Medicare systems to prevent non-hospice providers from providing vaccines to hospice beneficiaries.  The effective date is October 1, 2013 and the implementation date is October 7, 2013. 

To obtain direct reimbursement from Medicare for providing vaccines they must be enrolled in the Medicare Part B Program.  These vaccines cannot be billed to Medicare on the UG04 Hospice Claim.  They must be billed on the Form CMS-1500.  If a hospice does not have a Medicare supplier number, they should contact their Medicare Administrative Contractor (MAC) to obtain the number.

For more information please utilize the following link for CMS Transmittal:

http://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r1217otn.pdf

For Information on Hospice Billing for Vaccines see the following link:

http://www.cgsmedicare.com/hhh/education/materials/BIIPPV.html

Government Issues Final Rule on Companionship Exemption

On October 1, 2013 the Department of Labor published a final rule regarding the companionship services exemption to clarify and narrow the duties that fall within the term: in addition third party employers, such as home health agencies, will not be able to claim the exemption.  The major effect of this Final Rule is that more domestic service workers will be protected by the Fair Labor Standards Act (FLSA) minimum wage, overtime, and recordkeeping provisions.  The rule goes into effect on January 1, 2015.

If a person is employed directly by the person, they have the opportunity to obtain a companionship exemption if the personal care services are less than 20% of the total amount of services provided. 

This is a very detailed ruling.  We will be adding this to one of our new DixonHSI-LIVE events.  Look for more information about this topic in the future.

For more information please utilize the following link:

http://www.gpo.gov/fdsys/pkg/FR-2013-10-01/pdf/2013-22799.pdf

Government Shutdown Will Not Delay Medicare Payments

The Government Shutdown that went into effect at Midnight on October 1, 2013 will not delay Medicare Payments.  A short memo on the CMS Medicare Learning Network this morning stated that Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payments. 

It is unclear if this will impact state survey activities or appeal reviews by administrative law judges.  We will notify you in a future email blast when these issues have been clarified.

New Generic Drugs for 2013 and 2014

Millions of people are currently utilizing brand name prescription drugs that have premium prices.  Excellus Blue Cross released a fact sheet that contains a list of 37 brand name prescription drugs that are scheduled to become available in their generic form in 2013 and 2014.  Many of your home health and hospice patients may utilize some of these name brand prescription drugs. 

To obtain the detailed information please utilize the following link:

https://www.excellusbcbs.com/wps/wcm/connect/3b077339-3270-41fc-90cb-1d781c5af698/Generic+Savings+2013-2014+FS-EX+FINAL+1.pdf?MOD=AJPERES&CACHEID=3b077339-3270-41fc-90cb-1d781c5af698

CMS May Combine ZPICs and MACs

CMS is in the planning stages of developing a new program integrity entity.  This new program entity is a Unified Program Integrity Contractor (UPICs) and it would consolidate the Zone Program Integrity Contractors (ZPICs) and the Medicare Administrative Contractors (MACs).  This will not impact the Recovery Audit Contractors (RACs).  This is in the very early planning stages. 

For more information on CMS solicitation of information please use the following link:

https://www.fbo.gov/index?s=opportunity&mode=form&id=daa5a47204cdac248f44083b0103e309&tab=core&_cview=1

HIPAA Videos From Office of Civil Rights

The Office of Civil Rights (OCR) has published two YouTube videos summarizing the HIPAA omnibus rules.  The HIPAA rules become enforceable on September 23, 2013.  The first is a short video provides a high level review of the HIPAA rules.  The second even shorter video explains HIPAA rights to patients.

The first video can be found at the following link:

https://www.youtube.com/watch?v=mX-QL9PoePU

The second video can be found at the following link:

https://www.youtube.com/watch?v=3-wV23_E4eQ