Home Health & Hospice Week

Plus: Period for non-billing before deactivation will get cut by half.

Hospices aren’t the only provider types who have to worry about beefed up enrollment procedures in the newest home health rule.

The Centers for Medicare & Medicaid Services includes a number of enrollment program integrity provisions that affect home health and hospice agencies, as well as other provider types, in the home health 2024 proposed payment rule.

For example: CMS clarifies the “provisional period of enhanced oversight” for new providers for future PI actions. “We propose in new § 424.527(a) to define a ‘new’ provider or supplier … exclusively for purposes of our PPEO authority … as any of the following:”

• a newly enrolling Medicare provider, including those under new CIMO provisions;
• a certified provider undergoing a change of ownership consistent with the principles of 42 CFR 489.18, including those that qualify for an exception under § 424.550(b)(2); and
• a provider “including an HHA or hospice … undergoing a 100 percent change of ownership via a change of information request under § 424.516,” the rule says.

CMS used its PPEO authority to subject new home health agencies to Request for Anticipated Payment suppression in the last year of RAPs, the agency recalls in the rule.

CMS also proposes a change to close a loophole that allowed HHAs that refrained from billing after their placement in the PPEO to circumvent the enhanced oversight mechanism by holding RAPs until after the specified period. “Once their PPEO lapsed, the HHA engaged in improper billing without the intended oversight,” CMS recounts.

That change is “that the effective date of the PPEO’s commencement is the date on which the new provider or supplier submits its first claim (rather than, for example, the date the first service was performed or the effective date of the ownership change),” CMS offers. This new requirement should “help stem” such practices and “the provider or supplier would be unable to avoid the PPEO by delaying billing until the PPEO’s expiration,” the rule explains.

CMS proposes two more PI enrollment changes as well:

1. Reducing the period of Medicare non-billing for which a provider or supplier can be deactivated under § 424.540(a)(1) from 12 months to six months.
2. Allowing a provider to request a retroactive termination date “only if no Medicare beneficiary received services from the facility on or after the requested termination date,” the rule notes. “This … caveat would financially protect beneficiaries by helping to ensure that Medicare may still cover the services furnished to them near the end of the provider’s operations,” CMS explains.

The tightening of broader enrollment procedures for all providers took Dave Macke with VonLehman by surprise, he tells AAPC. Perhaps the focus on hospice enrollment bled over into the wider category as well.