Home Health & Hospice Week

If you receive more outlier payments than average, you may soon be in the hot seat.

The HHS Office of Inspector General advises the Centers for Medicare & Medicaid Services to "review home health providers that exhibit aberrant outlier payment patterns," according to the OIG's new Compendium of Unimplemented Recommendations. That's despite CMS putting a 10 percent cap on HHA outlier payments last year.

"CMS reported that its Miami Field Office implemented a new Fraud Prevention and Early Abatement approach to home health care that focused on performing data analysis and beneficiary interviews for those highly suspect new home health providers," the report says.

Meanwhile: Expect a proposed rule this fall that "will require unannounced and extended surveys of HHAs, and the imposition of sanctions when HHAs are found to be out of compliance with the Federal standards," the report says. That comes after the OIG's 2008 report recommending that CMS establish intermediate sanctions to address agencies that are repeatedly found out of compliance with the HHA conditions of participation.

On the hospice side, the OIG wants CMS to strengthen its monitoring of hospice claims for patients who are nursing home residents. In a review, 82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements.

The OIG also wants CMS to survey hospices more frequently. That's a statutory issue that Congress must address, CMS responds. Durable medical equipment suppliers had the highest number of unimplemented recommendations, by far. The 11 recommendations range from further reducing the oxygen rental period to beefing up review for wheelchair and inhalation drug claims. The compendium is at http://go.usa.gov/462.