Flublok Influenza Vaccine Approved For Adults 18 And Older

Protein Sciences Corporation has announced that the U.S. FDA has approved the Flublok influenza vaccine for adults 18 and older. Flublok is now a good option for older patients who have yet to be vaccinated this season.

Flublok is the only licensed recombinant flu vaccine and the only flu vaccine that is 100% egg-free and purified. The Flublok vaccine also contains three times more antigen than traditional flu vaccines.

If you need to order Flublok, please contact FFF Enterprises at 800-843-7477 or online at http://www.myfluvaccine.com

OIG 2015 Work Plan Released

The Office of the Inspector General (OIG) has just released its 2015 Work Plan and it looks a lot like its 2014 plan. The OIG will still be focused on inappropriate Part A and Part B billing in Nursing Facilities; general inpatient care billing for Hospice; compliance with PPS requirements in home health, with special scrutiny on newly enrolled home health agencies as well as review of employment of individuals with criminal convictions in the home care setting. The OIG will also still be looking at inappropriate Part B billing for Chiropractor services; place of service coding errors for Physician services; and the high use of outpatient Physical Therapy services.

To read the OIG’s full plan, click here.

That’s A Wrap! The Affordable Care Act, One Year Later Series Comes To An End

Throughout the month of October, HMS has explored the ins and outs of the Affordable Care Act. Our The Affordable Care Act, One Year Later Series has investigated both the positive and negative aspects of the new health law. It’s been one year since the implementation. Overall, how has the ACA impacted healthcare in America? Our final post in the series will examine if the health law did, in fact, do what it was intended to do-which is reduce the number of Americans without health insurance, make health insurance more affordable, and make Americans healthier.

According to a recent New York Times article, the ACA has indeed reduced the number of Americans without health insurance.  Although a perfect measurement of the number of people affected by the law is still difficult, most private sector surveys and government reports, including a Gallup poll, The Commonwealth Fund, and a CDC survey, reach the same basic estimates. The number of uninsured Americans has been reduced by 25 percent this year-that’s eight to 11 million people. More than half of that appear to be the newly insured who have signed up for Medicaid. Others are enrolled in private health plans through the new state insurance marketplaces. Three to four million people, mostly young adults, also became newly insured through ACA provisions that kicked in. The Congressional Budget Office estimates that by 2017, approximately 26 million more Americans will become insured through the law (lower than previously estimated).

Another question we all have: Is the Affordable Care Act actually affordable? According to the Obama administration, eighty-five percent of those who signed up during enrollment period qualified for federal subsidies to help pay premiums. The subsidies are estimated to have lowered the cost by 76 percent on average. However, the law has also required insurers to provide more benefits to cover people with pre-existing conditions, subsequently causing premiums to rise for some of those who already had insurance. Others plans were canceled or were not eligible for subsidies. On a more positive note, it has also been reported that premiums may actually become lower in the next year due to spurred competition among insurers.

Lastly, has the ACA made us healthier? Most experts believe it’s still too early to know. How will the ACA fare in the long run? Only time will tell!

*You can start shopping for health insurance on Saturday, November 15. If you want coverage to start on January 1, you’ll have to buy it by December 15. If you  miss the December 15 deadline, you can buy coverage, but it will not take effect until February 1 at the earliest.

CMS Announces 2015 Medicare Payment Changes For Home Health Agencies

CMS has announced changes to the Medicare home health prospective payment system (HH PPS) for CY 2015 to increase efficiency, flexibility, payment accuracy, and improved quality.

CMS projects that Medicare payments to home health agencies in CY 2015 will be reduced by 0.30 percent, or $60 million. This decrease reflects the effect of the 2.1 percent home health payment update percentage ($390 million increase) and the second year of the four-year phase-in of the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor (2.4 percent or $450 million decrease).

Notable changes:

  • CMS is eliminating the physician narrative requirement for F2F.
  • CMS will require physicians to have sufficient documentation in their own files to support the certification of homebound status and skilled care need. CMS will allow agencies to provide their record to the certifying physician so it can be included in considering if sufficient documentation exists to support the certification. CMS has also modified the rule to require that certifying physicians submit their records to agencies whenever a claim is audited for compliance.
  • Rate rebasing will continue with an $80.95 base episode reduction offset by a 2.1% inflation update (2.6 MI minus 0.5 productivity adjustment) along with the second year adjustments to LUPA and NRS rates. The productivity adjustment is 0.1% greater than proposed leading to a slightly lower inflation update.

Click here to view the final rule. This link will change once it is published in the Federal Register on November 6, 2014.

Click here for additional information about the Home Health Prospective Payment System.

The Affordable Care Act, One Year Later: The Losers Part II

In our last post, we looked at those who have been negatively affected by the Affordable Care Act. In this post, we will continue to explore the so-called “losers” of the health law.

  1. People with incomes under 100% of the poverty line living in states that didn’t expand Medicaid. Twenty-five states didn’t expand Medicaid under the ACA. The result? More than one-third of their lowest-income residents remaining uninsured-a rate that hasn’t changed from last year (even as millions gained coverage in states that expanded Medicaid). The ACA makes Medicaid available to anyone who earns less than 138 percent of the federal poverty level, or $16,105 this year for a single person. The law also lets individuals who make between the poverty level to four times that amount get tax credits to cut the cost of private health insurance. However, anyone making less than that or nothing, gets no assistance if they live in states that didn’t expand the program.
  2. Young, healthy people with higher incomes. With new insurance policies under the ACA, younger people are facing higher rates and higher deductibles.
  3. Person whose doctor is out-of-network. Some consumers are finding it difficult to find networks that include their current doctor. People have to make the choice to stick with their current doctor and pay more for insurance or switch doctors and pay less.
  4. People who don’t want to buy insurance coverage, who will still be uninsured and will have to pay a penalty.
  5. Unauthorized immigrants who are not eligible for any part of the ACA. Also, low-income authorized immigrants who have lived in the United States for less than five years and therefore are not eligible for Medicaid.

In our last post of our ACA series, we will wrap things up by looking at the overall impact of the health law. Stay tuned!


Stark Law & Anti-Kickback Waivers Extended For ACOs

The Office of the Inspector General and CMS recently announced that waivers to the Anti-Kickback Statute and Stark Law for Medicare Shared Savings Program accountable care organizations will be extended through November 2, 2015. CMS and the OIG published an interim final rule with a comment period that established waivers of the applications of Stark Law, the Anti-Kickback Statute and certain civil monetary penalties to ACOs participating in the Shared Savings Program on November 2, 2011. According to the interim final rule, the waivers were to expire next month. Extending the waivers will support agencies’ goals “to balance effectively the need for ACO certainty, innovation, and flexibility in the Shared Savings Program with protections for beneficiaries and the Medicare program.”

Click here to see the interim final rule.

Click here to read more.


VA To Pay Non-Contract Providers Using Medicare Payment Models

According to NAHC, the Department of Veterans Affairs (VA) has started issuing notices to inform home health providers of the VA’s revised payment methodology for SNF services. Starting on October 1, 2014, the VA will require an Outcome and Assessment Information Set (OASIS) to be completed to generate a health insurance prospective payment system (HIPPS) code to reimburse non-contracted home health agencies for skilled home health services using the Medicare home health prospective payment system (HHPPS). The VA will continue to pay a per diem rate for non-contracted hospice providers.

Click here to read more from NAHC.