House Lawmakers Looking to Relax Anti-Kickback Rules in Value-Based Care Arrangements

A bipartisan group of U.S. lawmakers is looking to relax federal anti-kickback rules related to how, when and where physicians refer their patients. Doing so could mean smoother referral relationships for home health providers, especially the biggest ones and those operating within an accountable care organization (ACO). Efforts to loosen anti-kickback regulations come from the […]

CMS Made $3.2 Billion in Improper Home Health Payments in 2018

Despite increased oversight efforts, improper payments under Medicare and Medicaid are costing the federal government billions of dollars, a new report from the watchdog arm of Congress has found. And home health providers appear to be the root of the problem. In fiscal year 2018, improper Medicare fee-for-service (FFS) payments totaled $31.6 billion for all […]

MA Risk Adjustment Fails to Account for Beneficiaries’ Functional Limitations

Due to current risk adjustment methods, Medicare Advantage (MA) plans may be underestimating annual fee-for-service spending for beneficiaries with functional limitations and overestimating spending for those without them. If true, that could mean an even greater MA role for home health providers, who routinely gather, store and analyze data related to the functional ability of […]

HME Industry Rallies Against Competitive Bidding

Home medical equipment (HME) providers say proposed changes to audit and competitive bidding programs for medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers¬†should be implemented before the end of the year. As the August legislative recess is underway, industry stakeholders are voicing support for H.R. 5083, or the Medicare DMEPOS Audit Improvement and Reform (AIR) […]