Medicare Contractors Were Not Consistent In How They Reviewed Extrapolated Overpayments

The Office of Inspector General (OIG) of the Department of Health and Human Services conducted an audit to determine whether the Centers for Medicare & Medicaid Services (CMS) ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements. The OIG concluded that the MACs and…

CMS Clarifies Hospice Election Statement and Election Statement Addendum

NAHC Hospice Webinar Series: Modified Hospice Election Statement and NEW Election Statement Addendum – Part I New hospice webinar series begins Wednesday, September 16, 2020 from 2:00 to 3:30 PM Eastern. REGISTER NOW! The Centers for Medicare & Medicaid Services (CMS) finalized in the Fiscal Year (FY) 2020 Hospice Wage Index and Payment Rate Update…

CMS Updates MAC “Cost Report Acceptability Checklist”

The Centers for Medicare & Medicaid Services (CMS) has updated the Cost Report Acceptability Checklists used by the Medicare Administrative Contractors (MACs) and has issued them as part of Change Request 11644/Transmittal 10316: “Revision to the Cost Report Acceptability Checklists”. Cost Report Acceptability Checklists are used by the MACs to determine if a particular cost…

Update: Post Payment Medical Review Topics

As previously reported, the Centers for Medicare & Medicaid Services (CMS) authorized the resumption of medical reviews to begin in August. Since the original resumption announcement, hospices and home health agencies have learned that medical reviews administered by the Medicare Administrative Contractors (MACs) will be service-specific post payment reviews. NOTE: Targeted Probe & Educate (TPE)…

Medical Review Resumes This Month

The Centers for Medicare & Medicaid Services (CMS) will resume medical revnew this month after originally delaying the program during the COVID-19 public health emergency (PHE). (NAHC Report originally reported this news on July 9.) On March 30, CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic and, seemingly, for the…

Home Health & Hospice Providers: Quality Reporting Resumption and Letters of Noncompliance

NAHC Report wants to remind both hospice and home health providers that quality data reporting  resumed July 1, 2020. For three calendar quarters – October 1, 2019 through June 30, 2020 – the Centers for Medicare & Medicaid Services (CMS) provided an exception for hospice and home health providers from submitting quality data due to…

Program Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability

The Centers for Medicare & Medicaid Services (CMS) recently released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft.…

Home Health Reminder and CMS Update to PDGM Split Implementation Instructions

REMINDER: Home Health RAPs Hold Medicare Administrative Contractors (MACs) typically hold claims for a brief period each quarter when they implement system releases. This January, home health Requests for Anticipated Payment (RAPs) are affected by implementation of the Home Health Patient-Driven Groupings Model. MACs will hold RAPs with From Dates on or after January 1,…

Attention Billers: Medicare Secondary Payer Problem With HETS

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) are aware of a problem with the HIPAA Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) data received from the Common Working File (CWF).  The MACs’ eligibility systems/portals that receive MSP data from HETS may be affected by this issue. Due…

CMS Notifying Agencies of Non-Compliance

Also, you may download preview reports and star rating reports from January 2020 refresh The Centers for Medicare & Medicaid Services is providing notifications to Home Health Agencies that were determined to be out of compliance with Home Health Quality Reporting Program (HH QRP) requirements, which will affect their CY 2020 Annual Payment Update (APU).…