With major regulatory volleys such as the Patient-Driven Groupings Model (PDGM) and the Review Choice Demonstration (RCD) on the table, keeping track of other industry-shaping issues can often feel like a losing battle. For some home health stakeholders, that may have meant missing a subtle yet important announcement from the Centers for Medicare & Medicaid Services (CMS) from earlier this year.
In a February Medicare Learning Network (MLN) publication, CMS highlighted a new initiative that would place certain home health care agencies under “enhanced oversight” for a set period of time.
Specifically, the initiative applies to all newly enrolled home health agencies, which CMS defines as those certified to participate in Medicare after Jan. 1, 2019.
Congress gave CMS the authority to launch the enhanced oversight initiative as a part of the Affordable Care Act (ACA). It did so in an effort to curb fraud, waste and abuse from providers and suppliers to the Medicare program.
“The ACA provides pre-payment review and pre-payment caps as examples of appropriate enhanced oversight,” Leslie Demaree Goldsmith, co-chair of Baker Donelson’s health care reimbursement group, told Home Health Care News. “However, the statute does not limit CMS to these actions. CMS has not provided information regarding what it will be examining or how it will do the review.”
Memphis, Tennessee-based Baker Donelson is a law firm that provides services in more than 30 practice areas.
In general, the enhanced oversight initiative is consistent with the increased scrutiny the home health industry has seen from federal watchdogs of late.
Additionally, the move to keep a closer eye on new home health agencies isn’t altogether surprising, as CMS announced in February it was lifting a long-standing moratoria on new agencies opening in a handful of states.
“We should expect the Medicare Administrative Contractors (MACs) to be examining the same requirements for payment that they have been focusing on for [home health agencies] over the last few years,” Goldsmith said.
CMS did not provide comment on its enhanced oversight initiative prior to the publication of this story.
While few details have been released about the nature of CMS’s review during the enhanced oversight period, home health agencies affected by the initiative will be informed via letter.
Once begun, the oversight time period could last anywhere from 30 days to a year.
Additionally, the increased oversight period will also place a hold on Requests for Anticipated Payments (RAPs), which are the upfront payments home health agencies receive ahead of a 60-day episode of home health services.
Home health agencies are still required to file RAPs for their final claims payments to be processed and paid.
CMS’s enhanced oversight initiative will likely be in place for the foreseeable future — and could potentially be applied to other health care providers moving forward, Goldsmith said.
“If CMS finds the enhanced oversight to be productive in identifying or deterring fraud, waste or abuse, we can expect to see the activity continued,” she said. “I would expect to see CMS roll out enhanced oversight of other provider or supplier types it believes are at high risk for fraud. The authority is, however, restricted to new providers.”