Medicare Fraud: Home Health & Hospice Agencies Beware

Over the years, our industry has seen reports of crimes related to Medicare fraud including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. Recently, the OIG released its Health Care Fraud and Abuse Control Program Report for FY2017. In its report, the OIG discusses several significant criminal and civil investigations into fraudulent practices by home health and hospice agencies.

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FY2019 Hospice Proposed Rule: What You Need to Know

On April 27, 2018 CMS released the FY2019 Hospice Proposed Rule. The rule includes a proposed increase in hospice reimbursements as well as changes to the Hospital Quality Reporting Program (HQRP), although no new measures are proposed.
Highlights of the FY2019 Hospice Proposed Rule include:
Payment Update
CMS is proposing a 1.8% increase in reimbursements to hospices with an overall economic impact estimated to be $340 million in increased payments to hospices during FY2019.

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Medicare Beneficiary Identifier (MBI): What Home Health & Hospice Agencies Need to Know

Designed to help protect the privacy of Medicare recipients, a new Medicare Beneficiary Identifier (MBI) will replace the social security number-based Health Insurance Claim Number (HICN) for Medicare transactions such as billing, eligibility status, and claim FISS/DDE submissions starting April 1, 2018.
Beginning in April, CMS will mail new Medicare cards to all people with Medicare on a flow basis by geographic location and other factors.

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Home Health Final Rule Released for 2018

On November 1, 2017, CMS released the 2018 Home Health Final Rule. To the delight of home health agencies, the rule was finalized without the implementation of the Home Health Groupings Model (HHGM), which was proposed for roll-out in 2019.
CMS stated, “We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

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Emergency Preparedness Training Open to Home Health & Hospice

Home health and hospice providers have until November 15, 2017 to implement and be in full compliance with the new emergency preparedness requirements. Now is the time for agencies to get ready with HEALTHCAREfirst‘s emergency preparedness training courses!
CMS has developed an Emergency Preparedness Training: Basic Surveyor Course to train surveyors on what to look for when evaluating providers for compliance with the emergency preparedness requirements.

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Longitudinal Charting in Home Health Care

Home health agencies have had longitudinal charting looming like a shadow over their operations. On one hand, implementing a longitudinal charting methodology makes it easier to track care activities in more nuanced and specialized ways, leading to potential quality and transparency improvements within an agency. On the other, the extra time and attention that goes into documentation with a longitudinal chart methodology can be intimidating for agencies already facing regulatory challenges and pressures.

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Home Health Emergency Preparedness: A Guide to Site Survey Success

Beginning on November 15, 2017, home health agencies must be prepared to demonstrate compliance with the home health emergency preparedness condition of participation (CoP). When evaluating for compliance with the CoP requirements, surveyors will follow the standard survey protocols during initial, revalidation, recertification, and complaint surveys. CMS’ goal in enforcement of these requirements is to ensure that Medicare certified organizations “better anticipate and plan for needs,

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Hospice Compare is Now Live

As anticipated, today CMS launched Hospice Compare, a website that reports information on hospices that enables patients, family members, and health care providers to learn more about the quality of care each hospice provides. Utilizing CMS’ official Hospice Compare datasets, Hospices can be evaluated based on quality indicators such as the percentage of patients checked for pain or percentage of patients asked about preferences for life-sustaining treatment.

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