Medicare Compliance & Reimbursement

As of July 1, 89 new Accountable Care Organizations (ACOs) have started serving 1.2 million people. In a press release issued by Health and Human Services (HHS), Secretary Kathleen Sebelius applauded "every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care."

"Better coordinated care is good for patients and it saves money," she said.

Participation in an ACO is purely voluntary for providers. The Medicare Shared Savings Program (MSSP), and ACO initiatives are made possible by the 2010 Affordable Care Act, the July 9 press release points out. It also estimated that in four years the Federal savings from this initiative could be as much as $940 million.

"This new group of ACOs adds to a solid foundation. The Medicare ACO program opened for business in January and, already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives," Centers for Medicare & Medicaid (CMS) Acting Administrator Marilyn Tavenner said in the same press release.

To learn more about the ACOs announcement visit: www.cms.gov/apps/media/fact_sheets.asp

Another Major Step Towards Affordable Care

The Obama Administration is putting its money where its mouth is as evidenced in the announcement of a new funding opportunity for states preparing to implement the new health care law.

"This new funding opportunity will give states the resources they need to establish affordable insurance exchanges and ensure Americans are no longer on their own when shopping for insurance," Health and Human Services Secretary Kathleen Sebelius announced in a June 29 HHS press release.

HHS also issued further guidance to help states understand the full scope of activities that can be funded under available grants as they work to build exchanges, the press release added.

The HHS guidance providing information on the exchange-building activities that states can fund with cooperative agreements can be found at: www.cciio.cms.gov/resources/factsheets/hie-est-grant-faq-06292012.html.

For more information on exchanges, including fact sheets, visit www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

OIG Wants CMS To Strengthen Medicaid Home Care Oversight

The Affordable Care Act appears to be doing its job when it comes to encouraging Medicaid use of home care. So suggests a new Government Accountability Office report.

The ACA established two new Medicaid home care programs with financial incentives: the Community First Choice and Balancing Incentive Program. And the health care reform law revised two existing programs -- Money Follows the Person and the 1915(i) state plan option.

As of this April, 13 more states had received $621 million in Money Follows the Person grants, the report notes. One state had applied for Community First Choice, four had applied for BIP, and three states received approval from the Centers for Medicare & Medicaid Services to offer the revised 1915(i) option.

Stay tuned: The U.S. Supreme Court has upheld the ACA. But you may still see some of the options available under the law dismantled if its political opponents are successful in their attempts at repeal or revision.

In the meantime, the HHS Office of Inspector General examined oversight of quality of care in Medicaid home care programs. In fiscal year 2010, Medicaid expenditures for home and community-based services (HCBS) waiver programs serving the disabled or elderly totaled an estimated $8.9 billion, the OIG says in a new report.

"Strong oversight of waiver programs is critical to ensuring the quality of care provided to HCBS beneficiaries," the OIG says. "The beneficiaries who rely on HCBS waiver programs are among Medicaid's most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care."

Problem: "Seven of the twenty-five States that we reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries," the OIG found in its study.

Solution: The OIG wants CMS to provide more HCBS guidance to states; require plans of correction from states that don't meet quality oversight standards; require onsite visits of HCBS programs; and make quality information public. CMS agreed with the recommendations. However, "we believe that the efficacy of a site visit must be evaluated prior to any decision to conduct a site visit," the agency pointed out in its comments on the report.

When a state meets all its quality standards, for example, "the agency reserves the discretion to determine that a site visit may not be required."

The GAO report is online at www.gao.gov/products/GAO-12-649 and the OIG report is at http://oig.hhs.gov/oei/reports/oei-02-08-00170.asp.

CMS Offers NPI Search Tip

You can now resume your regularly scheduled NPI checks. CMS has now resolved "the latency and performance issues experienced with the National Plan and Provider Enumeration System (NPPES)," the agency reports. "The National Provider Identifier (NPI) Registry is fully operational again."

To avoid future problems, CMS encourages users of the NPI Registry to exit the NPI Registry search and search results pages once they have completed their searches. "Users who do not exit off of the NPI Registry search pages will get a 'servlet error message' as a result of the timed out session (if session is idle)," CMS notes. Users then will have to log back into the system from the home page and start over.

Home Health & Hospice MAC Debuts New Resource To Help You Figure Out CERT Denials

Denials from the Comprehensive Error Rate Testing (CERT) project can confuse providers, but don't forget you can appeal.

Resource: If your HHH MAC is National Government Services, you can use its new CERT Denial Reason Finder self-service tool to locate the denial reason definition, understand why the claim was denied, view CERT reviewer comments, and learn how to correct the error, NGS says in a message to providers.

You can find the tool at www.ngsmedicare.com/wps/portal/ngsmedicare/certstatus. You just enter the CERT claim identification (CID) number in the tool's search form field then select "Submit." You can appeal the decision online at the MAC's NGSConnex.com online portal.