More cuts ahead for Home Health Providers, according to national experts

Representatives from 3 leading home health organizations are reporting that CMS’s proposed HHPPS rule would reduce Medicare Home Health funding by 3.5% each year from 2014 to 2017, resulting in a 14% cut in reimbursement, or $22 billion over ten years. This is on top of $72.5 billion in Medicare cuts already imposed by other legislative or regulatory changes.

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Nursing Home Survey Reform

A 2009 report found that 46% of surveyors and 36% of directors felt there were weaknesses in the traditional survey methodology for nursing homes. Finally, new legislation is being crafted and pushed through the House. A new bill will target improving the nursing home survey process, enhance whistleblower protections for surveyors and establish an advisory committee for CMS.

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Lessons Learned From Pioneer ACOs

As previously reported, nine Pioneer ACOs backed out of an experiment aimed at changing the way medical providers are payed. Although the departure of nearly 1/3 of participants occurred, it was expected seemingly because no model may be right for every population in every community. Two takeaways from the model program were that “ACOs will only succeed over the long term if they genuinely engage patients, families and consumers, in a comprehensive way, in both their design and their implementation, Ness and Kramer said.”  Also, patience in the adjustment period and patience in dealing with hardships will ultimately strengthen the delivery of primary care.

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CT Health IT Investments

As the Obama Administration threatens to penalize healthcare providers that do not use electronic medical records by 2015, hospital officials say the total costs of investing in technology are straining their bottom lines.  According to the Centers for Medicare and Medicaid Services, CT healthcare providers have been funded $161 million in federal health IT funds since 2011.  While this seems to be a large figure, it does not cover the total costs of investing in technology.

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August 1 Reporting Deadline

Another stipulation of the Affordable Care Act will be effective August 1st.  The Physician Payment Sunshine Act is designed to expose financial relationships between doctors and industry and requires physicians and teaching hospitals to annually report gifts and payments they receive from medical device and pharmaceutical manufacturers. Group purchasing organizations and drug and medical-device manufacturers will have to report any “transfers of value” of $10 or more they make to doctors and teaching hospitals.  Manufacturers must begin collecting data by August 1st, 2013 and reporting the data to CMS by March 31st, 2014.

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Are You Ready For ICD-10?

HMS Healthcare Management SolutionsDecisionHealth’s ongoing National Physician Practice ICD-10 Readiness Study bodes that more than 25% of physician practices say they don’t expect to be ready for ICD-10 by October 1, 2014. The Centers for Medicaid & Medicare Services project the Medicare denial rate to go up from 6% to 10% after ICD-10 is implemented.  For more information regarding preparation for the ICD-10 transition click here.

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CMS Instructs Incarcerated Beneficiary Claim Issue

The Centers for Medicare and Medicaid Services (CMS) initiated recoveries from providers and suppliers based on data that indicated that the beneficiary was incarcerated on the date of service (DOS).  Providers receiving demand letters with appeal instructions from CMS for overpayments due to claims paid for incarcerated beneficiaries are being asked not to file appeal requests.

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