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Take A Look At Latest PDGM Clarifications from CMS

One piece of information you may find surprising from an Aug. 21 Centers for Medicare & Medicaid Services education call, “Home Health Patient-Driven Groupings Model: Operational Issues,” regards payment hold time. As always, Medicare contractors will hold home health agency claims between Jan. 1 and when system changes get installed — this year, Jan. 6. The period of time is usually

New Medicare Card: Transition Period Ends in Less Than 5 Months

Members, please pay close attention if you are a Medicare provider. All new Medicare cards have been mailed. The Centers for Medicare and Medicaid Services (CMS) is encouraging providers to use Medicare Beneficiary Identifiers (MBIs) NOW to protect patients’ identities as providers must use MBIs beginning January 1, 2020. Providers claims will get rejected if they submit with Health

Can an ACO Benefit Independent Physicians?

An Accountable Care Organization (ACO) is a voluntary association of healthcare providers that bases physician reimbursement on performance quality and outcomes in order to lower overall costs. This method incentivizes physicians to deliver higher-quality care at an affordable cost, and is replacing the traditional fee-for-service model that has dominated healthcare in the past. The Medicare

Bankruptcy Court Stops Medicare from Recouping Monies Owed by Provider

A Delaware Bankruptcy Court Judge has entered an order prohibiting Medicare from withholding payments to a diagnostic testing provider, True Health Diagnostics, LLC, while the bankruptcy case is pending. Prior to filing the bankruptcy case, Medicare identified two large overpayments owed by True Health and also suspended its future payments. The Judge determined that it

Medicare’s New ‘Preclusion List’

By way of background, let’s start with a short Medicare primer. The federal Medicare program is a government health insurance program that pays for certain health care services for individuals who are 65 or over and have paid into Social Security and Medicare through payroll taxes for the required periods; certain younger people with disabilities;

NAHC Submits Comments to CMS on Proposed Home Health Cost Report Changes

The National Association for Home Care & Hospice (NAHC) and the Home Health Financial Managers Association (HHFMA) submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed changes to the home health cost report (Form CMS-1728-19) and cost reporting instructions. On April 16, 2019, the CMS published notice in the Federal Register of plans to revise the

How will the EMPOWER Care Act affect HHAs?

The Empower Care Act (Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care) was re-introduced to the senate early in 2019. This bill is intended to expand as well as renew/reauthorize funding and participation in the transitioning of Medicaid beneficiaries from hospital or institutional settings to home and community-based services under the Money Follows

Program for Evaluating Payment Patterns Electronic Report

New Home Health Agency PEPPER Available The Q4CY18 release of the Home Health Agency (HHA) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through December 2018 is now available for download through the PEPPER Resources Portal. To obtain your agency’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer should: Review the

July 2019, Quarterly Release Temporary Hold

Each quarter, the Fiscal Intermediary Shared System (FISS) is updated to include new logic for claims processing, pricing, etc. When the release is installed, Palmetto GBA places a temporary “hold” to ensure the release is installed properly. During this time, claims with dates on service of July 1, 2019, or later will be held in

What Physicians should know about Value-Based Payment Models

Payment models have undergone numerous and frustrating changes over the past few years, and the implementation of the value-based reimbursement model is no exception. Physicians submitting claims to Medicare have likely experienced the changes relating to this payment model. Value-based reimbursements are/were intended to compensate providers based on performance and guidelines focused on improving patient