Medicare Compliance & Reimbursement
Day Care Demo Project Comes With Strings
Details about the medical adult day care demonstration project have emerged, and they're making some home care providers think twice about getting involved.
The Centers for Medicare and Medicaid Services is soliciting applications for the demonstration, in which Medicare home health patients could receive a portion of their plan of care services in an adult day care facility.
Unwelcome surprise: CMS took many home care providers unawares in the July 18 special Open Door Forum on the demo. Under the project, HHAs must pay day care facilities for the entire day of day care when a patient receives a plan-of-care-covered service that day, explained Armen Thoumaian, CMS project officer for the demo. That includes transportation to and from the facility, Thoumaian said.
CMS won't allow the day care facility to bill either the patient or any other third party for that day of service. The same goes for transportation services.
CMS' "interpretation that [the] HHA is responsible for purchasing the entire day of services runs counter to my impression of the statute," Bob Wardwell of the Visiting Nurse Associations of America said in the forum.
The Medicare Modernization Act is clear that day care facilities can't receive duplicate payments for services rendered as part of the home health plan of care.
But nowhere does the law indicate that the HHA must pay for the entire day of care, including many services not on the POC, said Wardwell, a former CMS top official.
Medicare Compliance & Reimbursement
- MEDICARE PART D:
Part D Sponsors Prep For Advertising 'Blitz'
Medicare plans with strong reps are in best market position.
With the new Medicare drug benefit [...] - MEDICARE PART D:
Beneficiaries Confused About Part D Benefit
Lack of knowledge concerns industry insiders.
Providers that are having trouble deciphering the Medicare Part D [...] - MEDICAID:
Study Finds Elderly Patients Getting Subpar Care
Quality of care tethered to physician training, experience.
Few elderly Medicaid patients receive routine preventive health [...] - SKILLED NURSING FACILITIES:
AHCA Doles Out SNF Financing Tips
Organization asks CMS for more level payment differential.
The American Health Care Association is generally pleased [...] - HOSPITALS:
Cuts Cut Both Ways, Hurt Hospitals And Private Payers
Low Medicare, Medicaid payments force hospitals to overcharge commercial plans.
Health plans having a hard time [...] - HOSPITALS:
Payment Increases Highlight Proposed OPPS Rule
Medicare patients could enjoy lower coinsurance rates for outpatient services.
The Centers for Medicare and Medicaid [...] - PAY-FOR-PERFORMANCE:
Docs Will Likely Have To Bend On P4P
Insiders cannot foresee a future without P4P measures.
Washington observers say it's increasingly likely that physicians [...] - DME:
Suppliers Now Allowed To Deliver Home Oximetry Tests
CMS reins in self-testing limits.
Durable medical equipment suppliers will soon be able to deliver [...] - HOME HEALTH:
Day Care Demo Project Comes With Strings
Tab for transport, care must be paid by participating HHA.
Details about the medical adult day [...] - ENFORCEMENT WATCH:
Medicaid Patients Must Verify Home Health Claims
State AG pursues civil fraud lawsuit against a home health facility.
Filing false home health claims [...] - HOME HEALTH:
CMS Says 2-Sheet Review Notices OK
... but providers better use carbonless paper to garner the required exception.
New information about the [...] - BILL WATCH
The following bills were introduced in the Senate: S. 1563. A bill to amend title [...]
