New Hospice Supplemental Medical Review Contractor Project

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The Centers for Medicare and Medicaid (CMS)’  Supplemental Medical Review Contractor (SMRC), Noridian Healthcare Solutions LLC, has posted a new hospice project, Hospice 90 Day Stay Notification of Medical Review.  This is a post-payment review of claims for Medicare hospice billed on dates of service from January 1, 2021 through December 31, 2021 for patients […]

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HHS Financial Report for 2021 Identifies Increases in Hospice Payment Error Rates

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Increases not “statistically significant”, according to HHS On an annual basis, the Department of Health & Human Services (HHS) issues a financial report that provides fiscal and high-level performance results that allow for the assessment of HHS’ performance over the previous fiscal year.  Last week HHS issued its FY2021 HHS Agency Financial Report (Report) containing an overview […]

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HHS Financial Report for 2021 Identifies Increases in Home Health, Hospice Payment Error Rates

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Increases not “statistically significant”, according to HHS On an annual basis, the Department of Health & Human Services (HHS) issues a financial report that provides fiscal and high-level performance results that allow for the assessment of HHS’ performance over the previous fiscal year.  Last week HHS issued its FY2021 HHS Agency Financial Report (Report) containing […]

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Comprehensive Error Rate Testing Review Update

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Effective August 11, 2020, the Centers for Medicare & Medicaid Services (CMS) resumed Comprehensive Error Rate Testing (CERT) program activities that were temporarily suspended in response to the public health emergency (PHE). Specifically, the CERT program resumed sending documentation request letters to and conducting phone calls with providers or suppliers to request medical documentation for […]

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Improper Payment Rates for Home Health and Hospice Providers Decreased in 2019

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The improper payment rate for home health providers in 2019 dropped 5.5 percent to 12.1 percent, from last years’ rate of 17.6 percent. Non-hospital based hospices had an overall improper payment rate of 8.9 percent, a 2.1 percent drop from 11 percent in 2018 and hospital based hospices had an 18.9 percent improper payment rate, […]

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OIG Report Recommends CMS Use CERT Data to Identify High Risk Home Health Agencies

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CMS Remains Opposed to Using CERT Data to Identify Improper Payments, Prefers TPE & RCD The Health and Human Services (HHS) Office of the Inspector General (OIG) recently released a report pertaining to home health agencies (HHA), The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home […]

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Office of Inspector General Continues Focus on Home Health Agencies

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The Department of Health and Human Services (HHS), Office of the Inspector General (OIG) issues updates to its work plan on a monthly basis through out the year. Since our last report on the OIG’s recent activity updates (NAHC Report https://report.nahc.org/recently-added-oig-work-plan-item-may-impact-home-health-and-hospice-providers/), the OIG announced this month a revision of an issue for home heath agencies […]

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Hospice Supplemental Medical Review Contractor Activity

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The Centers for Medicare and Medicaid (CMS)’ Supplemental Medical Review Contractor (SMRC), Noridian Healthcare Solutions LLC, has posted a current hospice project – General Inpatient Hospice.   CMS contracted with Noridian on February 13, 2018 to help lower improper payment rates and increase efficiencies of Medicare and Medicaid medical review. The SMRC conducts medical review of […]

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Special Alert for All Home Health Operators!

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An extremely serious issue involving Medicare home health has surfaced that requires the immediate attention of your organization. Effective January 13, 2018, the “Plan of Care” (POC) Condition of Participation under 42 CFR 484.60 also became a Condition for Payment under the home health benefit, 42 CFR 409.43. This means that all the elements must […]

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Improper Payment Rates Fall for Home Health and Hospice Providers

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Improper payments to home health providers fell by almost 15 percent and to hospices by three percent, according to the 2018 Medicare Fee-for-Service Improper Payment Data report. As NAHC has stated previously, these sharp reductions in improper payments demonstrates that Center for Medicare & Medicaid Services’ (CMS) plan to initiate the Review Choice Demonstration is […]

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In Light of New Evidence, NAHC Pushes OMB, CMS to Back off Review Choice Demonstration

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The National Association for Home Care & Hospice (NAHC) is calling on the Office of Budget Management (OMB) and the Centers for Medicare & Medicaid Services (CMS) to stop the planned Review Choice Demonstration (RCD) before it begins, in light of new evidence showing that “improper payments” in home health have been rapidly declining without […]

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CMS Home Health Open Door Forum on Templates and Clinical Data Elements

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The Centers for Medicare and Medicaid Services (CMS) will hold a special home health open door forum conference call on templates and clinical data elements (CDEs) on Thursday, March 1, 2018 from 3:00 to 4:00 PM Eastern time. The special open door forum will allow physicians, provider and supplier professional associations, and/or all other interested […]

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