ZPICs Are Prominent – Article by Michael McGowan
Posted: 11.19.15 | Category: Corridor Solutions
There is a growing number of Florida Medicare home health agencies that are receiving notices from a Zone Program Integrity Contractor (ZPIC) stating that they are being investigated for a wide range of things, from waste, to abuse or even Medicare fraud. They have been instructed that their patient records will be reviewed and their claims payments could be reversed, as well as fines will be assessed. We are learning that this is becoming common-place across our nation.
In looking for a cause for this activity, it has been found that as high as 80% of agencies still have no understanding of Medicare’s Conditions of Payment. For more information regarding this issue, click here.
Tags: CMS, Corridor, Corridor Solutions, home care, Home Health, Medicare Conditions of Payment, ZPICs
Senate Bill for Home Health Care Planning Improvement Act Has Growing Sponsorship
Posted: 11.10.15 | Category: Corridor Solutions
The Home Health Care Planning Improvement Act (S. 578/H.R. 1342), is receiving a growing number of bipartisan sponsors. This bill would allow non-physician practitioners (NPP) to have the ability to certify Medicare services. The home care and hospice community is seeing their work payoff, with it’s current 40 bipartisan members of the U.S. Senate, and 153 members of the House of Representatives supporting this bill. The National Association for Home Care had set 40 sponsors as their original goal, and are now looking to increase that to 50 Senate cosponsors in hopes this bill will pass.
Read the full article here.
Tags: Corridor, Corridor Solutions, Home Health, Hospice, NAHC, National Association for Home Care and Hospice, The Corridor Group
Medicare Validity Upheld by Courts While Restricting Scope of F2F
Posted: 11.04.15 | Category: Corridor Solutions
A decision was issued November 3rd by US District Judge Christopher R. Cooper in the NAHC lawsuit which challenged the validity of the Medicare rule regarding the face-to-face narrative requiring physicians to document the face-to-face encounter with their patients. It was argued by NAHC, that it was unreasonable for claims to be denied based on the narrative, when the entire patient record supports the Medicare coverage. However, Judge Cooper granted “Summary Judgment” to the U.S. Department of Health and Human Services that the F2F law did not preclude the interpretation of “document” that was established by CMS. The court determined that it is a “reasonable way to verify that an appropriate encounter took place.”
NAHC is evaluating the next best steps to take on the ongoing face-to-face requirements controversy. Val. J. Halamandaris, NAHC’s President stated, “Our fight to overturn these wrongful denials is not over. We will take every course of action available to protect home health agencies from the wrongful denial of claims under the misguided physician narrative policy.” For more information click here.
Tags: Corridor, F2F, Home Health
Possible Entitlement Cuts as the Fiscal Deadline Approaches
Posted: 10.25.15 | Category: Corridor Solutions
There are 2 major federal government deadlines:
- November 3, 2015 – Congress to raise the federal debt limit to prevent the government from risking default
- December 11, 2015 – Congress to pass legislation to fund the federal government to prevent government shutdown
Some lawmakers raised the prospect of some potential cuts to programs like Medicare and Medicaid. NAHC is monitoring this and opposes any offset that would impose HHA copays or include payment rate cuts. HHA copays would be a “sick” tax and additional payment rate cuts would directly impact access to care for Medicare home health beneficiaries.
Many leaders have expressed strong opinions and NAHC encourages everyone to contact members of Congress using NAHC’s Legislative Action Center (click here), and ask them to oppose any home health copays or payment cuts to offset the cost of any legislation.
Click here to read more.
Tags: Corridor, Home Health, Medicare
Reminder: Home Health Probe & Educate Reviews To Begin October 1
Posted: 09.30.15 | Category: Corridor Solutions
Earlier this year, CMS announced its plans to conduct a Probe and Educate review on home health claims to ensure agencies understand the new certification requirements, specifically, the revised Face-to-Face encounter requirements, effective January 1, 2015.
The reviews will begin October 1, for claims with episodes that begin on or after August 1, 2015. However, the specifics of the review, including the number of claims, length of review, and education methods, have yet to be published.
Click here to read more.
Tags: CMS, Corridor, Face To Face, Home Health, Medicare