Home Health & Hospice Week
BRACE YOURSELF FOR MORE CASE MIX CREEP CUTS
CMS also dishes on COPs, survey sanctions, homebound definition. The Services is conducting analysis of patient coding and payment to determine if there has been further case mix creep for home care patients, CMS's Lori Anderson said at a National Association for Home Care & Hospice conference March 23. Case mix creep occurs when home health agencies code patients as more severe (thus costing Medicare more money) while the patients' conditions remain at the same level of acuity. Last time CMS did such analysis, it added a 2.71 percent cut to HHApayment rates in 2011. That was on top of the 2.75 percent cuts in each year from 2008 to 2010 that CMS designated in its original case mix creep analysis. CMS should know in a few weeks if it has detected case mix creep that will require further cuts, Anderson told conference attendees. Other topics covered by CMS officials in the home health regulatory panel include: • Survey sanctions. Unlike other provider groups like nursing homes, HHAs have no intermediate sanctions for poor survey performance -- they either can submit a plan of correction or get terminated, noted CMS's Jan Tarantino in the session. CMS is now developing such alternative sanctions for agencies. For example, nursing homes can be subject to civil money penalty (CMP) fines. At this time, CMS has no plans to develop such sanctions for hospice providers, Tarantino confirmed in a separate conference session on hospice regulations. • MAC transition. Only one of the four home health Medicare Administrative Contractors is proceeding with the intermediary-to-MAC transition at this time, noted CMS's Mark Zobel. That's because the contractor awards in three of the four HH MAC regions are being protested. National Heritage Insurance Corp., which is using existing intermediary National Government Services as its home health contractor, will begin handling Medicare claims May 15, Zobel noted. The Government Accountability Office will make decisions on the other three protests by early May and the transitions will proceed from there, Zobel said. New headache: HHAs, hospices, and other providers will no longer be able to use "provider nomination" to choose a Medicare contractor that is not in their geographic region, Zobel confirmed.That means providers in a chain will have to submit claims to different MACs based on their location. However, providers won't have to switch to their geographic MAC immediately. All providers will stay with their current contractor region for the time being, but will move to their geographic one eventually, Zobel explained. • HHA COPs. Hospices have been wrestling with their new Medicare conditions of participation for months, and it looks like HHAs may get their turn soon. CMS is still working on the long-delayed HHA COPs, Tarantino said in the session. "Maybe this time we'll get them out," she joked. • CARE tool. Another patient assessment tool change may be around the corner for HHAs. Nearly 150 providers, including 40 HHAs, are currently testing the Continuity Assessment Record and Evaluation (CARE) tool, noted CMS's Shannon Flood in the panel. The CARE tool collects data with the same assessment tool across multiple post acute settings -- HHAs, long-term care hospitals, inpatient rehab facilities, and skilled nursing facilities. CMS is using the tool in its Post Acute Care (PAC) Payment Reform Demonstration, which is proceeding in 11 markets this year. Items on the new OASIS C tool were crafted with the CARE tool in mind, CMS said. Resource: More information on the CARE tool and the PAC demo is at www.pacdemo.rti.org. • HHAs should review the homebound definition,which specifies patients may have absences that are infrequent and of short duration if they require a taxing effort, Anderson reminded attendees.
Home Health & Hospice Week
- OASIS:
START OASIS PLANNING NOW THAT 'TENTATIVE FINAL' OASIS C IS OUT
'Final final' version expected in late summer, CMS says. After some initial scrambling, the feds [...] - Hospice:
HIGHER HOSPICE PAYMENT RATES ARRIVE APRIL 3
Big cuts still lie ahead for industry, feds warn. Hospices should finally begin seeing payment [...] - Fraud & Abuse:
GAO SLAMS HHA FRAUDSTERS IN HIGH-PROFILE REPORT
Are payment cuts, another Operation Restore Trust in the industry's future? Once again, a few [...] - Regulations:
BRACE YOURSELF FOR MORE CASE MIX CREEP CUTS
CMS also dishes on COPs, survey sanctions, homebound definition. If you've been suffering under the [...] - Studies & Surveys:
THESE HOSPICE STUDY FINDINGS MAY SURPRISE YOU
New reports challenge physician attitudes, cultural preferences. Your job with your hospice patients may be [...] - Industry Notes:
FEDS SHOULD TOUGHEN UP SURVEYS, NEW REPORT URGES
Home care providers could see more frequent visits from surveyors. The Government Accountability Office has [...]
