Home Health & Hospice Week

But charges apply only to revisits.

Prepare to pay up if you get cited with a major deficiency in your next survey.

Congress authorized charging survey and certification fees to Medicare providers in its last appropriations bill, Centers for Medicare & Medicaid Services' Pat Sevast said at the National Association for Home Care & Hospice's policy conference in Wash-ington, DC April 23.

Now CMS is ready to issue the proposed rule on the fees, Sevast told a packed conference room. The fees will apply to surveys undertaken because the provider received a deficiency in its regular survey that required a revisit survey. Condition-level deficiencies always require revisit surveys, Sevast reminded attendees.

Exemption: The fees will apply to most providers that receive surveys, including home health agencies and hospices, but won't apply to rehab facilities and providers, Sevast explained.

Congress expects the new charges to raise $35 million that will go to cover revisit survey costs, Sevast noted. CMS will adjust the user fee rate annually.

Sevast couldn't reveal how much the survey fees will be because CMS hadn't yet published the rule. But she did say that "I thought they were cheap." She added, "when I saw them, I didn't think they were that high."

CMS will adjust the fees based on the pro-vider's size, the survey size and other factors, she said.

Withhold costs: Providers were chagrined to learn that the fees will be taken directly out of their Medicare reimbursement from the intermediary, instead of going through the state survey office.
 
Hurry Up And Wait For Your Survey HHAs must receive a survey at least every three years and may be surveyed based on a complaint. CMS also asks states to pick a 5 percent sample of agencies to survey randomly, Sevast said.

Survey backlog: Many states have backlogs for initial Medicare certification surveys because they barely have the resources to survey current providers along that required timeline, notes Chicago, IL-based survey consultant Rebecca Friedman Zuber. Agen-cies looking to get into the Medicare business should be prepared for a long survey wait in states like Illinois, Michigan and Texas.

Protest: Conference attendees protested that they could be charged fees for unfair survey findings. CMS should put an appeal process in place for deficiencies cited if they are going to start assessing fees based on them, one provider maintained. And CMS should require higher qualifications for surveyors, another urged.

"We understand some people have problems with citations," Sevast allowed. She noted fees will apply only when providers are "way out of compliance" for condition-level deficiencies. "We don't plan to increase the number of revisits made," she added.

And CMS is intensifying training for surveyors, Sevast promised.

Note: To sign up for a May 2 Eli teleconference presented by Rebecca Friedman Zuber on [...]