CMS to Publish MAC “Cost Report Acceptability Checklists” in Medicare Manual

The Centers for Medicare & Medicaid Services (CMS) has published a transmittal (Transmittal 2273/Change Request 10920) indicating intent to publish (as Exhibits in a forthcoming revised Chapter 8 of the Medicare Financial Management Manual) Cost Report Acceptability Checklists for Hospitals, SNFs, Home Health Agencies/Hospices, and Home Offices that are currently used by the Medicare Administrative…

CMS Updates Providers on PDGM and Quality Reporting Program

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice & DME Open Door Forum yesterday where CMS representatives provided information on the new Home Health Patient Driven Grouping Model (PDGM), the home health quality reporting program and the Hospice Quality Reporting Program.  A summary of the information shared is below. Home…

CMS Issues Instructions for PDGM Claims Processing

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 11081, which provides claim processing  instructions to the Medicare Administrative Contractors ( MACs) that will be necessary to process home health claims with the implementation of the Patient Driven Groupings Model (PDGM). The PDGM will assign 30-day periods of care into one of…

Hospices: The Time is NOW to Ensure You are Effectively Managing Your Aggregate Cap Responsibilities

  –NAHC Offers Free Webinar to Members to Advance Industry Expertise The National Association for Home Care & Hospice (NAHC) will hold a critical webinar that every hospice provider needs to attend – Mastering Management and Calculation of the Hospice Aggregate CAP. The webinar will take place on Tuesday, February 5, 2019 from 1:00 PM…

Hospices: The Time is NOW to Ensure You are Effectively Managing Your Aggregate Cap Responsibilities

NAHC Offers Free Webinar to Members to Advance Industry Expertise The National Association for Home Care & Hospice (NAHC) will hold a critical webinar that every hospice provider needs to attend – Mastering Management and Calculation of the Hospice Aggregate CAP. The webinar will take place on Tuesday, February 5, 2019 from 1:00 PM to…

Special Alert for All Home Health Operators!

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…

CMS Further Modifies Processes Related to Redesign of Hospice Periods in CWF

Earlier this year the Centers for Medicare & Medicaid Services (CMS) issued a MLN Matters Article (SE 18007 – Recent and Upcoming Improvements in Hospice Billing and Claims Processing) that announced significant changes to the way hospice periods are configured in the Common Working File (CWF).  MLN SE 18007 also announced improvements to the way…

CMS Holds Hospice, Home Health “Patients over Paperwork” Listening Sessions at NAHC Conference

–Sessions part of CMS’ expansion of “customer engagement” initiatives Approximately one year ago the Centers for Medicare & Medicaid Services (CMS) announced its “Patients over Paperwork” initiative, under which the agency began in-depth discussions on steps that could be taken to reduce unnecessary regulatory burdens on health care providers, increase efficiencies, and improve the beneficiary…

CMS Revises Instructions for Statistical Sampling

The Centers for Medicare & Medicaid Services(CMS) has issued Change Request (CR) 10067 which revises instructions to the CMS medical review contractors (Medicare Administrative Contractors (MACs), the Recovery Audit Contractors (RACs), the Supplemental Medical, Review Contractors (SMRCs), and the Unified Program Integrity Contractors (UPICs)) on the use of statistical sampling for overpayment estimations. The revised…

CMS Stipulates Credentials of Medical Reviewers

The Centers for Medicare & Medicaid Services (CMS) released Change Request 10909, which requires that the Medicare medical record review contractors ensure medical review audits are conducted by registered nurses, therapist or physicians. The requirement applies to the Medicare Administrative Contractors (MACs), the Comprehensive error Rate Testing Contractors (CERT), the Recovery Audit Contractors (RACs), the…