Category: Home Health

Action needed: Register for an iQIES Account

The Quality Improvement and Evaluation System (QIES), which providers and vendors use to submit assessment data, is being upgraded to make the system more reliable, scalable, secure, and accessible.  The enhancements will occur in phases (by provider type) and began with Long- Term Care Hospitals (LTCHs) in March 2019, followed by Inpatient Rehabilitation Facilities (IRFs)

Congress Debates Bill to Automate Prior Authorization in Medicare Advantage Plans

Recently the House of Representatives’ Small Business Committee convened for a hearing on utilization management and barriers to care in small medical practices. In particular this hearing focused on the application of prior authorization within Medicare Advantage (MA) plans and the associated challenges faced by patients and providers of services due to prior authorization requirements.

Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,” he said. Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight

Increased Enforcement Against Home Health Agencies

With the recent rise in medical services provided outside of a doctor’s office, there has been a surge of FCA enforcement actions against home health agencies (HHAs). HHAs are public or private agencies or organizations that are primarily engaged in providing skilled nursing services and other therapeutic services to patients in their residence.[1] The last

Medicare decides a cost-saving strategy costs too much

After pushing more medical care out of hospitals and into patients’ homes, the federal government wants to pay less for home health care. Impending changes in Medicare’s home health payment system would dramatically alter how agencies are reimbursed for services, cutting payments by 8 percent. Lower rates would squeeze profit margins in what has been

Medicare Sequester Extended Two Years

The Bipartisan Budget Act of 2019, signed into law last week by President Donald J. Trump, includes an extension of the Medicare sequestration cuts for an additional two years. This across the board cut of two percent applies to all Medicare provider payments. The Bipartisan Budget Act of 2019 will increase federal spending by $320

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

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