NAHC Adds ICD-10 Resource Page To Its Website

NAHC has added an ICD-10 Resource Page to its website to help home care and hospice agencies transition to the new coding system, and to provide up-to-date information on the ICD-10 update. NAHC and the home health and hospice vendor community have a shared goal in assuring that agencies are adequately preparing for the transition from ICD-9 to ICD-10 diagnosis coding. The page includes education and guidance materials along with tools to assist NAHC’s members in attaining that goal.

Click here to see it.

Medicare Looks to Cut Spending on Post-Acute Care

Researchers have discovered huge discrepancies in how much Medicare spends on nursing homes, home health services, and other post-acute services around the country.  For example, in Louisiana, Medicare spends $8,800 per patient for home health care as opposed to $3,300 per patient in New Jersey.  Because of discrepancies like these, Medicare is seeking to gain more control over what it spends on services patients receive after leaving the hospital.

Medicare spent $62 billion last year- one out of every six dollars on traditional fee-for-service programs.  Experts agree that this “hodgepodge of payment methods” encourage “unnecessary and disjointed” care which wastes taxpayer money and makes fraud easier.  They also agree that hospitals usually don’t take costs into account when discharging patients.

Medicare is now experimenting with new payment methods such as bundled payments where hospitals and post acute providers work together to treat patients for a fixed sum (rather than getting paid for each service). Also, President Obama has proposed reducing payments for certain conditions to post-acute providers and paying the same rates for similar patients. Experts warn that the transition to a new payment method will not be an easy one.

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CMS Proposes Smaller Cuts for Home Health Providers

CMS issued a final rule last week announcing that it would reduce payments to home health providers by 1.05 percent in 2014 which is a smaller cut than the 1.5 percent cut previously proposed.  This payment “includes a 2.3 market basket increase, minus 2.73 percent for rebasing adjustments, and another 0.62 percent reduction tied to refinements in the home healthcare prospective payment system.”  In total, the cuts will cost $200 million for the coming year.

Earlier this year, CMS announced a plan to reduce home health reimbursements by 3.5 percent annually between 2014 and 2017 but has since backtracked fearing it would cost home health agencies too much.

Click here to read more

VA Delays Effective Date to Implement Payment Methodologies for Home Health & Hospice Providers

The Department of Veterans Affairs (VA) has issued a rule that delays the effective date for the billing methodology for non-VA providers of home health services and hospice care. In the May 6, 2013 Federal Register, the VA published a final rule which established a November 15, 2013 effective date to change the billing methodology for non-VA providers of home health services and hospice care that have not negotiated a rate with the VA. This announcement delays that effective date to April 1, 2014.

On February 18, 2010, the VA issued a proposed rule to implement certain payment methodologies for all non-VA inpatient and outpatient health care professionals and providers, which included paying according to Medicare fee schedules and prospective payment systems, as applicable. When the final rule was published on December 17, 2010, however, the regulation included an exception for implementing the payment methodologies for home health and hospice services.

The VA cited administrative and systems problems that prevented their ability to implement the Medicare payment system for home health and hospice services on such short notice.

Additionally, on May 6, 2013, the VA published a final rule that established an effective date of November 15, 2013 for the payment methodology for non-VA home health and hospice providers that do not have a negotiated contract with the VA.

Services provided by non-contracted home health and hospice agencies were to be paid the lowest of the following amounts:

  • The applicable Medicare fee schedule or prospective payment system amount (“Medicare rate”) for the period in which the service was provided;
  • The amount negotiated by a repricing agent if the provider is participating within the repricing agent’s network and VA has a contract with that repricing agent. For the purposes of this section, repricing agent means a contractor that seeks to connect VA with discounted rates from non-VA providers as a result of existing contracts that the non-VA provider may have within the commercial health care industry;
  • The amount that the provider bills the general public for the same service.

The VA has delayed the November 15, 2013 implementation date until April 1, 2014 due to unforeseen difficulties in contracting and information technology procedures required to apply the billing methodology to non-VA home health services and hospice care.

Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

Home Care Legislation Debate in California

Unions and organizations representing the elderly in California have pushed for legislation that would license agencies, certify workers, and create a publicly accessible caregiver registry.  Some home care agencies, described as nonmedical services for the elderly (bathing, dressing, and other basic tasks around the home) favor regulation but do not favor the specific measures. The legislation, Assembly Bill 1217, will be voted on the Senate floor this week after already passing the State Assembly.

In California, any organization which offers home care only needs a business license.  Currently, 27 states require home care agencies to be licensed and certified and rightly so.  A study published last year by Northwestern University found that few agencies perform thorough background checks or provide necessary training. Under the proposed Home Care Services Consumer Protection Act, home care agencies would be required to be licensed by the state by July 1, 2014 or be fined $900 a day.

Organizations in California which oppose the legislation say that they do not have an issue with the licensing and certification requirements, but do believe assuring the capability of their employees should be their responsibility and voluntary, not the state’s.  Home care organizations oppose a caregiver registry which would reveal the names of their workers to competitors and union organizers.  They also believe the extra costs could backfire and reduce the amount of workers in the industry.

Despite the opposition, there is strong support from organizations which represent home care workers such as the Direct Care Alliance.  Supporters want to make home care a legitimized profession where all agencies meet the same basic standards and regulations.

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Long Term Care Costs Continue To Rise

According to a recent report by Genworth Financial, the cost of long-term care is rising. The findings show the daily cost of a private room in a nursing home at $230 a day compared to $115 a day at an assisted-living facility. Those able to receive home care homes will pay an average of $19 an hour for a licensed home health aide.

Click here to read more. Click here to see how Connecticut compares to national averages.