COVID-19 Accelerated/Advance Payments Reminder — Get Ready for Repayment Withholds on Claims!

Medicare providers who qualified for accelerated and advance payments (AAP) during the COVID-19 Public Health Emergency (PHE) could have payments recouped in the next few weeks.  In the interest of improving cash flow for Medicare providers during the PHE, the Centers for Medicare & Medicaid Services (CMS) issued guidance in late March 2020 allowing providers…

CMS Updates Targeted Probe & Educate Information

The Centers for Medicare & Medicaid Services (CMS) published updated targeted probe and educate (TPE) information contained in Chapter 3 of the CMS Program Integrity Manual (Publication 100-08) through Transmittal 10132/Change Request (CR) 11695. The updates incorporate information about TPE practices providers have experienced, but were not clearly outlined in the Manual. This update includes…

CMS Updates Enrollment Decision Appeals Procedure

The Centers for Medicare & Medicaid Services (CMS) updated Chapter 15 – Medicare Enrollment –  of the Medicare Program Integrity Manual via Change Request (CR) 11210/Transmittal 936 Provider Enrollment Appeals Procedure. This CR deals with provider enrollment appeals and  provides instructions to the Medicare Administrative Contractor (MAC) on handling  reconsideration requests and Corrective Action Plans…

Hospices: Deadline for Self-reporting of Aggregate Cap is March 2

Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2019 Cap year by March 2, 2020 (NOTE:  the deadline usually is the last day in February, but because February 29 falls on a weekend, the deadline shifts to the next business day).  If you have a Cap-related liability, you are…

Appeals Demonstration Expanded to Home Health and Hospice

On Jan.1, 2016, the Centers for Medicare & Medicaid Services (CMS) launched the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration to test whether further engagement between Durable Medical Equipment (DME) suppliers and the DME QIC would improve the understanding of the cause of appeal denials and, over time, result in more proper…

MAC Listening Sessions – Your Opportunity to Provide Feedback

The Centers for Medicare & Medicaid Services (CMS) is holding listening sessions to gather feedback and improve experience with the Medicare Fee-For-Service (FFS) program. This is your opportunity to provide feedback on your MAC – Medicare Administrative Contractor. For home health and hospice there are three MACs: Palmetto GBA, CGS, and NGS. Medicare Learning Network…

Appeals Demonstration Expanded to Home Health and Hospice

On Jan.1, 2016, the Centers for Medicare & Medicaid Services (CMS) launched the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration to test whether further engagement between Durable Medical Equipment (DME) suppliers and the DME QIC would improve the understanding of the cause of appeal denials and, over time, result in more proper…

CGS Extends Direct Data Entry Deadline

CGS asked the National Association for Home Care & Hospice to share with our members that they have extended the deadline for direct date entry (DDE) renewal to November 15, 2019 due to the low percentage of providers having completed the process by the original deadline date.  As of today only 63% of CGS Home…

CMS Provides Direction to MACs on Use of Adjustment Codes

Via Transmittal 4415/Change Request (CR) 11113 – Medicare Administrative Contractor (MAC) Guidance Related to Use of Adjustment Codes on Adjustment Claims – the Centers for Medicare & Medicaid Services (CMS) directs the MACs to refine the claims adjustment reporting process to categorize adjustments by the origin of the adjustment request. The implementation date is January…

Have You Retrieved Your Hospice PEPPER?

Don’t miss this NAHC webinar on how to understand and use PEPPER. It’s free to members! As previously reported, the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) became available for hospices to download at the beginning of April. The PEPPER is only available via download from the PEPPER Resources portal.  PEPPER is a…