Medicare and Medicaid Requesting Comment on Proposed Changes to Home Health Regulations

A proposed rule issued July 1 by the Center for Medicare and Medicaid Services (CMS) (CMS-1611-P) looks to change payment rates for home health agencies and simplify the  face-to-face encounter regulatory requirements. The decrease in payments to the home health agencies will begin in 2015 and reduce the overall budget .30 percent, equivalent to $58 million dollars.

The Affordable Care Act mandates that individuals shifting from hospital care to home health meet with a physician to certify that the home health services are medically necessary. Current regulation requires that the meeting occur within 90 days prior or 30 days after services begin. Regulations also require documentation with a narrative explaining why the patient requires home services. The proposed rule eliminates the narrative requirement, reduces the CMS review to only the certifying physician’s medical records for initial eligibility, while the physician’s visit to patient’s home for certification would not be covered if the overall claim was not approved.

CMS is requesting comment by September 2, 2014.

Other proposed changes include:  changes to the home health quality reporting program requirements, rebasing of the 60-day payment rate, and simplifying the certification regulatory requirements.

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Posted in Affordable Care Act, Medicare/Medicaid

CMS Expands Proposed Five-Star Rating System for Providers

The Centers for Medicare and Medicaid Services have announced another expansion to their planned five-star rating system for various medical facilities. At present, CMS uses star ratings to allow consumers to compare Medicare Advantage plans and nursing homes on its website.

Over the past six months, CMS has stated that it would include star ratings on its Physician Compare website. Now, CMS will also include star rankings for hospitals, home health agencies, and dialysis providers. CMS plans on rolling out the new star ranking system in late 2014 to early 2015.

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Posted in Medicare/Medicaid

Latest Healthcare Premium Costs Within the Nebraska Exchange

The Congressional Research Service recently published the latest costs for a healthcare plan within the Nebraska Exchange. Every plan has variables that may affect the costs associated with securing health insurance. The Nebraska exchange costs follow the basic balancing of monthly premiums paid, coverage, and potential out of pocket costs. The average cost of a plan premium in the highest category of coverage within the Nebraska exchange is $443, with a range of $862 to $236. The $236 premium is for single adults age 21, while the $862 premium is for a single adult age 60. A basic summary of costs is provided below.

Congressional Research Service Summary Cost Data for Health Plans in Nebraska

 

Source: May 16, 2014, Congressional Research Service Summary Cost Data for Health Plans in Nebraska

 

A full copy of the report can be obtained at http://www.fas.org/sgp//crs/misc/R43549.pdf

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Posted in Affordable Care Act

HHS Proposes New Rules on Civil Monetary Penalties

HHS’s Office of the Inspector General (OIG) has issued a new proposed rule that makes a number of changes to its civil monetary penalty authority. Among other changes, this rule would increase the maximum reduction of penalties when providers can show mitigating circumstances. It also makes providers who cause more than $15,000 of losses to Medicare/Medicaid subject to increased penalties.

The rule also explains the factors that OIG will consider in determining how much in penalties it will assess. These include the provider’s history and whether other wrongful conduct was involved. OIG will also consider whether the provider followed self-disclosure protocols and took corrective action. Providers should review their self-disclosure policies to determine whether they reflect the new factors.

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Posted in Affordable Care Act, Ambulatory Surgery Centers, Billing, Business of Practice of Medicine, Health Care Clinics, Medicare/Medicaid, Practice Management

Nebraska Passes Bill Expanding Telehealth Coverage

The Unicameral has passed a bill that expands the definition of telehealth, which will presumably expand Medicaid coverage for these services. Under the new law, telehealth includes all usage of medical information electronically exchanged between sites to aid providers in diagnosing or treating patients. The bill explicitly includes telemonitoring and “store-and-forward” technology in the definition of telehealth. It also removes language from the prior statute that excluded telephone conversations, e-mails, and faxes from the definition of telehealth consultations.

The bill makes a number of other minor changes to the state’s telehealth laws. Specifically, it prohibits changes in reimbursement rates that depend on the distance between a patient and her healthcare provider. Thus, as a result of this bill, Nebraska providers may be able to claim reimbursement for new services, and are protected from changing reimbursement rates based on distance.

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Posted in Medicare/Medicaid, Electronic Health Care, Legislation, Telemedicine

CMS Seeks to Set New ICD-10 Deadline for October 1, 2015.

Although CMS has not officially established a new deadline for ICD-10 implementation after the 2014 deadline was delayed, October 1, 2015 appears to be CMS’s preferred deadline. In an unrelated rule recently released by CMS, it stated that it planned to schedule the ICD-10 transition deadline for that date.

CMS has since indicated that it expects to release an interim final rule in the near future that will officially set the ICD-10 implementation date for October 1, 2015. Like the prior deadlines, providers will be obligated to use ICD-9 until September 30, 2015.

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Posted in Medical Coding

Beware of “Accidental Contracts” With Insurance Providers

Health care providers should be aware that informational forms sent by insurers may lock them into unfavorable contracts. In many cases, these forms are faxed to front-desk staff or mailed to physicians at home. The form may include language that purports to be a contract binding the practice to lower reimbursement rates for certain groups of patients or services.

 While these practices may be challenged in court under a number of different theories, the easiest way to avoid these issues is preventive. Your practice should establish policies for handling information update forms and other correspondence from insurers. These forms should be signed only after careful review, and not by a physician without appropriate authority to do so or a front-desk staff person.

© 2014 Parsonage Vandenack Williams LLC

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Posted in Business of Practice of Medicine, Practice Management

Study Identifies Common Medicare Billing Issues

CMS has released results from its recent study on common billing mistakes by health care providers. Among the most common mistakes include unbundling – the practice of submitting claims by piecemeal to maximize reimbursements for tests and procedures that are required to be submitted together at a reduced cost.  Other common mistakes are using the wrong diagnosis code to support an MRI and coding a subsequent Annual Wellness Visit improperly as an initial wellness visit.

 The study also revealed that common forms of underbilling include coding for the wrong surgery and using a lower level of Evaluation and Management than the documentation supports.

More information on the study can be found at: Comprehensive Error Rate Testing (CERT).

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Posted in Billing, Coding Issues, Medical Coding, Medicare/Medicaid

FDA Releases New Report on Health IT Oversight

The FDA, in conjunction with other administrative agencies, has released a new report that describes its strategic plan for regulating health IT devices. The report suggests three different categories of health IT, based on the risks associated with each type. The lowest-risk category is administrative health IT functions. This includes software for admissions, scheduling, and practice management. The FDA has indicated that health management health IT functions pose a slightly higher risk. These include clinical decision support and medication management tools. Finally, the FDA identified medical device health IT functions, such as robotic surgical control and computer-aided detection software, as high risk areas.

The FDA has indicated that it will focus its attention on medical device health IT functions, and does not see a need for further regulatory oversight over the other two areas at this time.

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Posted in Business of Practice of Medicine, Electronic Health Care, Practice Management

Medical Providers Should Use Caution on Continued Use of Windows XP

Microsoft’s recent announcement that it will stop providing support for its Windows XP operating system could cause an increased HIPAA risk to certain medical providers. HIPAA generally requires medical providers to adequately safeguard its protected health information.  One effect of Microsoft’s decision is that it will no longer be helping to ensure that users of XP are secure from new forms of hacking and malware.  Therefore, medical providers using XP are at an increased risk of being attacked and possibly violating HIPAA.  To help prevent this, medical providers using Microsoft XP should ensure that their anti-virus software and firewalls are current while beginning to look into upgrading its operating systems.

© 2014 Parsonage Vandenack Williams LLC

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Posted in Business of Practice of Medicine, Electronic Health Care, HIPAA, Practice Management
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