Richard on YouTube about our new On-Demand Seminar

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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.

Medicare Home Health PPS Rules and Rates for 2013 July 10

July 10 - Medicare Home Health PPS Rules and Rates for 2013

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 Proposed Rates. We will follow up this email for the next few days with details on some of the areas.

  

More Detail on Proposed Medicare Home Health Payment Rates for 2013

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

   

Urban LUPA Rates	Proposed Rate 2013	Current Rate 2012	Increase
Skilled Nursing (2)	$114.57	$112.88	$1.69
Physical Therapy (2)	$125.28	$123.43	$1.85
Occupational Therapy (2)	$126.12	$124.26	$1.86
Speech Pathology (2)	$136.13	$134.12	$2.01
Medical Social Services (2)	$183.67	$180.96	$2.71
Home Health Aide (2)	$51.90	$51.13	$0.77
LUPA Add On (2)	$96.04	$94.62	$1.42

Rural LUPA Rates	Proposed Rate 2013	Current Rate 2012	Increase
Skilled Nursing (2)	$118.01	$116.27	$1.74
Physical Therapy (2)	$129.04	$127.13	$1.91
Occupational Therapy (2)	$129.90	$127.99	$1.91
Speech Pathology (2)	$140.21	$138.14	$2.07
Medical Social Services (2)	$189.18	$186.39	$2.79
Home Health Aide (2)	$53.46	$52.66	$0.80
LUPA Add On (2)	$98.92	$97.46	$1.46

(2) These rates must be adjusted by wage Index 

Medical Supply Payment Rates

Urban Payment Severity Level	Points (Scoring)	Relative Weight	Proposed Rate 2013	Current Rate 2012	Increase
1	0	0.2698	$14.59	$14.39	$0.20
2	1 to 14	0.9742	$52.68	$51.95	$0.73
3	15 to 27	2.6712	$144.46	$142.46	$2.00
4	28 to 48	3.9686	$214.62	$211.65	$2.97
5	49 to 98	6.1198	$330.96	$326.37	$4.59
6	99+	10.5254	$569.21	$561.32	$7.89

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%)