Tuesday, September 20, 2016

Free Webinar - “Home Health Update: Pre-Claim Reviews are Here And More HHS-OIG Audits are on the Horizon”

Date: Thursday, September 22, 2016 at 1:00 EST (Noon CST)

Summary:  The home health “Pre-Claim Review” demonstration project has now started and will be in place for at least the next three years. How did we get to this point?  Unfortunately, this demonstration project was initiated (in large part) based on the fact that improper payment rate for home health claims has gone 17.3 % in FY 2013 to 51.38% in FY 2014 and 58.95% in FY 2015. While the demonstration project only initially impacts home health agencies in five states, the problems areas noted will likely be pursued by CMS contractors around the country. Is your home health agency ready for this level of scrutiny?

The delay in the Pre-Claim Review moving forward to other states gives us the opportunity to learn from what has already happened.  It also shows how we can apply so of what we have learned to improve our home health documentation.

In addition to the program integrity initiative already underway, HHS-OIG has also ramped up its review of home health agency claims and has expressly advised agencies that they intend to seek extrapolated damages of any overpayments identified. We anticipate a new round of home health audit letter to be sent to agencies in Fiscal Year 2017 (Starting October 1, 2016).  What is HHS-OIG looking for?  Join us as we discuss this initiative and how your agency should respond if selected for audit.

Moderator: Richard Dixon
Speakers:  Robert W. Liles and Adam Bird.

Duration:  This webinar is scheduled for 60 minutes with a Q & A session to follow.

Liles Parker PLLCPresented by:    Liles and Parker, Attorneys and Counselors at Law

              Sponsored by:   Dixon Healthcare Solutions

Cost: Registration is free for Dixon Healthcare Solutions and Liles Parker clients and friends of the firm.

By signing up for this webinar, you permit Liles Parker to share your registration information with Dixon Healthcare Solutions.  You will also be placed on Liles Parker’s newsletter distribution list.

Questions? Please call Liles Parker with your questions, comments, and feedback at: 202-298-8750.

How to Register and Join the Webinar:

1.      Please register in advance for the webinar by clicking the following link:

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Access Code: 648-175-423
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Webinar ID: 591-369-515


CMS Places Expansion of Pre-Claim Audit on Hold

In an abrupt turn around CMS announced yesterday that the expansion of the Pre-Claim Audit for home health agencies in the states of Florida, Texas, Massachusetts, and Michigan has been placed on hold.  CMS intends to provide at least a 30-day notice before that move forward. 

CMS stated the delay is based on the early information from the state of Illinois.  They also indicated that additional education is needed before they can expand this program to the other states.

We can thank the various trade organizations, members of Congress, and public outcry for this delay.  Unfortunately, the program is still moving forward in Illinois.  We all need to continue to press our members of Congress to stop the program in Illinois and make the necessary changes before the program moves forward.  A letter from both Florida US Senators, they recommend if the program moves forward it should be scaled down approach with a random sample of a small number of claims.

Dixon Healthcare Solutions, Inc., has received information that the program is flawed with many failures points.  Some agencies are receiving a denial rate of 80% on their initial reviews.  The MAC (Palmetto GBA) has lost paperwork.  It is taking hours to submit the paperwork.   The MAC’s claim review workload has increased by 40 to 50 times.   The whole program is a mess.

Link to CMS Announcement

Tuesday, September 6, 2016

CMS Finalizes Hospice CAP for 2016 - 9/6/2016

CMS issued the final Per Beneficiary Hospice CAP for 11/1/2015 to 10/31/2016 amount of $27,820.75.  Remember you are required to complete your Hospice CAP Report for period 11/1/2015 to 10/31/2016 by March 31, 2017.  CMS is also changing the Hospice CAP Year to coincide with the federal fiscal year beginning 11/1/2016.  There will be a short period beginning 11/1/2016 to 9/30/2017.  All other Hospice CAP years will then begin in October 1st each year and end September 30th.
We have helped several clients complete their Hospice CAP Reports for a nominal fee in the past.  We have found that many hospices have trouble managing the per beneficiary cap.  We will be providing some new tools to manage the hospice cap to attendees of our “New Directions in Hospice Care” seminar to be held at Bally’s Las Vegas on January 26th to 27th.

Final Link

https://www.gpo.gov/fdsys/pkg/FR-2016-08-05/pdf/2016-18221.pdf