CMS: Hearings Related To State Survey Actions Must Be Filed Electronically

CMS has issued a survey and certification letter stating that effective October 1, 2014, providers that disagree with actions imposed on their agencies/facilities and want to request a hearing with an Administrative Law Judge in the Civil Remedies Division must submit their request electronically to the Departmental Appeals Board using the DAB E-File. Click here to see it. Petitioners must first become registered users to utilize the electronic filing system. The letter includes an attachment that provides instructions on how to register and use the DAB’s Electronic Filing System.

Please note, written requests for hearings delivered by postal delivery are no longer accepted unless the petitioner does not have access to the internet or a computer. In those instances, the petitioner may call the Civil Remedies Division and provide an explanation as to why they cannot file electronically.

Click here to read the letter.

Click here to read more.


Tiptastic Tuesday: CMS Reminds Providers About New Survey Appeals Process

CMS has reminded state survey agency directors that it will no longer accept appeals through “the U.S. mail from providers that disagree with actions imposed on their facilities.” Providers must electronically file a hearing request using the Departmental Appeals Board e-filing system. Providers must also register on the DAB website.

Petitioners without access to the Internet or a computer may request a waiver from e-filing if they call the Civil Remedies Division at (202) 565-9462 and explain why.

The change became effective on October 1, 2014.

Click here to see the CMS memo.

Click here to read more.

CMS Re-Enabling Registration In IACS System

In January, CMS began a planned one-week transition of the Provider Statistical and Reimbursement Report (PS&R) application from the IACS system to the EIDM system. However, there were technical problems with the transition and it was postponed until further notice. Providers that were not active in the IACS system at the start of the systems transition have not been able to register in the IACS system and are unable to access their PS&R reports, creating difficulties for a number of hospice providers relative to self-calculation and reporting of the 2014 aggregate cap as well as for home health providers that were under the deadline to meet cost reporting requirements.

Effective April 15, 2015, two of CMS’ HHH contractors (CGS and NGS) have announced that CMS is re-enabling registration in the IACS system.

Click here to access the CMS IACS Registration help.

Click here to read more.

Reminder: Educational PEPPER Webinar On April 30

CMS, through its contractor, TMF Health Institute, will be providing an educational PEPPER webinar for home health and hospice agencies on April 30 from 11:00 a.m. to 12:30 p.m. (CDT). The webinar will provide updates on the Q4FY14 PEPPER for Hospices, Skilled Nursing Facilities, Long-term Acute Care Hospitals, and Inpatient Rehabilitation Facilities. Additionally, the webinar will provide a preview of the PEPPER reports home health agencies will be receiving for the first time this coming July.

No registration is required to access the webinar. Click here at the time of the event.

The event number: 923 918 378

The event password: lantana

Click here to read more.

CMS Updates Program Integrity Manual

CMS has issued change request (CR) 9065 that incorporates provisions in the final rule (CMS-6045-F) entitled “Medicare Program; Requirements of the Medicare Incentive Reward Program and Provider Enrollment” into chapter 15 of the Medicare Program Integrity Manual. CR 9065 also addresses several minor provider enrollment policy issues. The CR incorporates provisions that strengthen enrollment policies related to denials and revocations. CMS also includes several factors to be considered when determining if uncollected debt poses an undue risk of fraud, waste, or abuse. One key provision of the rule expands the reason for revocations related to abuse of billing privileges. If a provider or supplier show a pattern or practice of submitting claims that fail to meet Medicare requirements, their billing privileges could be revoked.

Click here to see CR 9065.

Click here to read more.

CMS Likely To Deny Coverage For Pricey New Treatments

According to a new analysis on national coverage decisions between 1999 and 2012, getting medical devices, drugs and procedures covered by Medicare is becoming more difficult. In order to justify the cost, CMS requires more evidence that the new interventions are “reasonably necessary” and should be paid under the federal healthcare program. CMS is about 20 times more likely to say no in more recent years. Researchers analyzed 213 decisions made between 1999 and August 2012 and found that a total of 74 were denied coverage during that time period. The majority of the denials happened in more recent years with Medicare being less likely to pay if there were alternative interventions and no estimate of cost-effectiveness.

Click here to read more.

CMS Report: Early Results Show Slow Progress In CMS Readmissions Programs

CMS has released a report revealing that only a handful of several community groups that have received federal reimbursements for reducing preventable readmissions have delivered better results than programs that were not part of the initiative. Researchers analyzed 48 community agencies participating in the initiative to reduce 30-day readmissions among seniors. Only 4 of the 48 community agencies achieved substantial results compared to the control group. Despite these results, experts emphasize that it is still too early to draw broader conclusions. Other readmission reduction programs, including the Hospital Engagement Network,  have reported better results.

Click here to see the report.

Click here to read more.