New Innovation Model Tests Flexibility in Home Health and Hospice Benefits

The Centers for Medicare & Medicaid Services (CMS) has announced a new payment and care delivery model being tested by the CMS Innovation Center.  The Geographic Direct Contracting Model (also known as the “Model” or “Geo”) will test whether a geographic-based approach to value-based care can improve quality of care and reduce costs for Medicare beneficiaries…

Study: Medicare Home Health Benefit Not Sufficient to Meet Needs of Post-Acute Beneficiaries

Policy changes could increase value of home health benefit in COVID-19 era Home health care would be very effective providing services to Medicare beneficiaries, but the current design of the home health benefit is insufficient to meet the needs of post-acute beneficiaries, concludes a new study from the Commonwealth Fund. The report’s authors believe policy…

Medicare Fee-for-Service Estimated Improper Payments Fall $15B since 2016

The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Fee- For-Service (FFS) improper payment rate has continued to decline, the fourth year Medicare FFS improper payment rate has been below 10 percent, the threshold for compliance established in the Payment Integrity Information Act of 2019. The Medicare FFS estimated improper payment…

COVID -19 Therapeutic Receives Emergency Use Authorization

The Centers for Medicare & Medicaid Services announced that starting November 12, 2020, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat coronavirus disease 2019 (COVID-19) with no cost-sharing during the public health emergency (PHE). CMS’ coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization (EUA) from the U.S.…

Third Evaluation of Medicare Care Choices Model Finds High Satisfaction and Savings

Last month the Centers for Medicare & Medicaid Services (CMS) released its third annual report evaluating findings of the Medicare Care Choices Model (MCCM).  Broadly speaking, the evaluation indicates that the model holds great promise – beneficiaries enrolled in the model were 20 percent more likely to enroll in hospice and entered hospice one week…

New Target Area for Hospice PEPPER

The 2021 release of the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER), anticipated spring  2021, will include at least one new target area – Average Number of Part D Claims per Hospice Episode.  This target area will measure the count of Medicare Part D claims for beneficiaries billed during hospice episodes in the…

CMS Releases Interim Final Rule for COVID-19 Vaccine & Treatment, and CARES Act Provisions

Late in the day on Wednesday, October 29, the Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) primarily addressing COVID-19 vaccine coverage. The provisions of the IFC are effective immediately on the date of posting in the Federal Register or as otherwise specified in the rule. The…

OIG: Poor Oversight Led Medicare to Overpay for Hospital Inpatient Claims with Post-Acute-Care Transfers to Home Health

A new report from the Office of Inspector General (OIG) has found that Medicare improperly paid most inpatient claims to the transfer policy when beneficiaries resumed homoe health services within three days of of discharge but the hospitals failed to code the inpatient claim properly and recommends the Centers for Medicare & Medicaid Services (CMS)…

CMS Survey Data Illustrates Impact of COVID-19 on Medicare Beneficiaries’ Daily Life and Experiences

On Friday, October 16, the Centers for Medicare & Medicaid Services (CMS) released data showing that 21 percent of Medicare beneficiaries report forgoing non-coronavirus disease 2019 (COVID-19) care due to the pandemic, and nearly all – 98 percent – of beneficiaries have taken preventative measures to keep themselves safe from the virus. According to the…

Home Health Billing Reminder

As finalized in the CY 2020 Home Health Prospective Payment System final rule, the regulations at §409.44(c)(2)(iii)(C) were modified to allow therapist assistants (rather than only therapists) to perform maintenance therapy under the Medicare home health benefit. The Centers for Medicare & Medicaid Services (CMS) established two new G-codes to identify on home health claims…