House Passes Bill with Telehealth, Home Infusion Provisions

A bill that was passed by the House of Representatives last week, if passed by the Senate, will have an impact on several areas of the home health and hospice industry. The 21st Century CURES Act is a combination of the original CURES legislation, which was intended to make the FDA drug review process more efficient, […]

Pre-Claim Affirmations Hit 82% in Latest CMS Data

After more than three months of the pre-claim review demonstration underway in Illinois, new data from the Centers for Medicare & Medicaid Services (CMS) reveals that the vast majority of requests have been fully or partially affirmed. In week 14 of the demonstration, 82% of pre-claim review requests in Illinois received provisional affirmation, either fully […]

CMS Names Recovery Audit Contractor for Home Health

Home health agencies now know who will be performing controversial recovery audits on their Medicare claims. The Centers for Medicare & Medicaid Services (CMS) has chosen its second round of national Recovery Audit Contractors (RACs), including the first-ever that will be focused exclusively on durable medical equipment, home health, and hospice (DME/HH-H) claims. Five contracts have […]

NAHC to File Lawsuit to Stop Pre-Claim

A national association is striking back against the “failed” Pre-Claim Review Demonstration (PCRD) with a plan to file a lawsuit against the Centers for Medicare & Medicaid Services (CMS). The board of directors of the National Association for Homecare & Hospice (NAHC) has authorized a lawsuit against CMS, which the association says “is currently ravaging our […]

Tips for Getting Face-to-Face, Homebound Status Right

With margins tight, staffing pressures constant, client acuity rising, and a host of other challenges for home heath agencies, they can’t afford to see their Medicare reimbursements jeopardized or delayed. To make sure they’re getting the basics right, agencies may want to double-check their practices against the following information on face-to-face documentation and supporting homebound […]

Pre-Claim Tests Home Health, Physician Relationships

As Illinois home health agencies have grappled with numerous challenges imposed by the Medicare Pre-Claim Review (PCR) demonstration, making sure home health can work hand-in-hand with physicians has emerged as an acutely important issue. Under the PCR demonstration, agencies must submit claim documentation to a Medicare administrative contractor (MAC) for audit; affirmed claims may be submitted […]

How the ‘Re-Engineered Hospital’ Presents a Home Health Opportunity

Some big thinkers believe that the heart of the U.S. health care system is shifting away from hospitals and other institutional settings, into people’s homes. Those who need proof that this occurring may find some in New York City, where Mount Sinai Health Network is in the vanguard of providing hospital-level care for patients at […]

Kindred, NAHC Say to Hit the Brakes on Bundled Payments

The Centers for Medicare & Medicaid Services (CMS) is moving too quickly on bundled payments, according to some of the nation’s largest home health providers and industry associations. In April 2016, the mandatory Comprehensive Care for Joint Replacement (CJR) demonstration got underway. Under this program, hospitals in selected geographic areas would be responsible for controlling […]

States With the Highest Hospice Medicare Spending

Different states account for varying levels of Medicare spending on hospice patients, with Southern states in particular having the highest standardized Medicare payments per hospice beneficiary. That’s according to a new data set from the Centers for Medicare & Medicaid Services (CMS). The Hospice Utilization and Payment Public Use File, or “Hospice PUF,” contains information on […]

New Legislation Would Delay Pre-Claim One Year

A bill introduced in Congress this week would put a pause on the Pre-Claim Review Demonstration from the Centers for Medicare & Medicaid Services (CMS) with a one-year moratorium on the program. The legislation, introduced by Representatives Tom Price (R-GA-6) and James McGovern (D-MA-2), comes after the home health industry has pushed back hard against […]