New Legislation Introduced To Refine Hospice F2F Requirements

New legislation (HR 2208, The Hospice Commitment to Accurate and Relevant Encounters ACT – Hospice CARE) has been introduced to address “key issues related to the requirement that hospice providers conduct a face-to-face encounter with patients entering their third or subsequent benefit period to gather information that helps support documentation for continuing eligibility for hospice care.” The legislation would make the following changes into law:

  • It would allow any of the following practitioners to conduct the hospice face-to-face encounter: hospice physician, nurse practitioner, clinical nurse specialist, or physician assistance, or other health professional as designated by HHS.
  • In cases of a new readmission to hospice care where exceptional circumstances exist, it would allow the face-to-face encounter occur no later than seven calendar days after the individual’s election of services.

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Report: Medicare Fee-For-Service Consumes Most Medicare Outlays

According to a new report from the Catalyst for Payment Reform, more than half of the $360 billion in Medicare payments made two years ago were based on traditional fee-for-service models without regard to quality or value.

However, as the government moves toward outcomes-based payment models, the number is expected to shrink significantly. The U.S. Department of Health and Human Services (HHS) is pushing to tie at least half of all traditional fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2018.

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Tiptastic Tuesday: 4 Essential Steps For Healthcare Compliance

According to new guidance from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG), healthcare providers must focus on four major principles in order to create effective compliance programs.

The increase in fraud crackdowns means compliance is more important than ever. OIG collaborated with industry leaders to develop the four following guidelines:

  1. Define your audit, compliance and legal departments’ jobs and relationships with one another. Make sure each department understands its role in the compliance process.
  2. Assess your organization’s protocols for gathering information and reporting issues. Make sure each compliance-related sector reports on its compliance and risk-management efforts and measures its implementation of compliance programs.
  3. Identify and audit potential risk areas. Make sure to establish clear processes for risk identification.
  4. Encourage compliance throughout the enterprise. The OIG recommends regular performance assessments to help facilitate this process.

Click here to see the guidance.

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CMS Announces “Next Generation” ACO Model

Yesterday, CMS  launched a new Accountable Care Organization (ACO) initiative known as the Next Generation ACO Model. The new model “builds on the successes of earlier ACO models, such as the Pioneer ACO Model, and further enables innovation by providers to improve care for patients.” The Next Generation ACO offers new opportunities in accountable care, setting more predictable financial targets, and gives providers and beneficiaries more opportunities to coordinate care. The Next Generation ACO Model will take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings. Additionally, the new model encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries by enhancing services that beneficiaries can receive from participating ACOs.

For more information on the Next Generation ACO Model, click here.

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6.4 Million Have Already Enrolled To Obtain Healthcare Coverage For 2015

Between November 15 and December 18, enrolled 1.9 million new customers for health insurance. During the same time, 4.5 million existing policyholders re-enrolled or were automatically renewed into their existing policy or similar one beginning January 1, 2015. Health and Human Services Secretary Sylvia Burwell believes the numbers indicate “an encouraging start.”

For those who were re-enrolled, percentages around the mid-to high-30s logged into the system and either renewed their old plans or changed it to a different one. The rest were re-enrolled automatically. Anyone who was auto-renewed can change plans until February 15, 2015. Increased competition among plans, variations in premiums or benefits, and changes in financial circumstances have caused many people to switch plans.

Burwell remained tight-lipped about whether her department is making contingency plans in the event the Supreme Court rules that subsidies are not available in the 37 states where is operating the exchange.

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2015 OIG Work Plan Highlights: Home Health Services

HMS recently blogged about the 2015 Office of Inspector General (OIG) Work Plan. The 2015 Work Plan covers a broad range of topics related to CMS programs, organized by provider type. Here are some highlights from the home health services section:

The OIG will review compliance and various aspects of the home health prospective payment system (HHPPS), including the documentation required in support of the claims paid by Medicare. The OIG will determine if claims were paid in accordance with federal laws and regulations. The OIG notes that that a pior report found that one in four home health agencies had questionable billing. Due to their record of fraud, waste, and abuse, the OIG has designated newly enrolled home health agencies as high-risk providers.

The OIG will also examine records of home health agencies that employ individuals with criminal convictions. Most states have laws prohibiting healthcare entities, including home health agencies, from employing certain individuals with certain types of criminal convictions.

Click here to see the plan.

HHS Releases First Post-DOMA Memo Addressing Nursing Home Benefits for Medicare Advantage Enrollees

Current law gives Medicare patients enrolled in private Medicare Advantage plans the right to treatment in the same skilled nursing facility where their spouse resides.  The U.S. Department of Health and Human Services recently issued a memo clarifying that this rule applies to same-sex spouses as well.  This is expected to be the first of many steps HHS takes to equalize the way Medicare benefits are administered.

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