HHS Extends Application Deadline For Insurers

Earlier today, the Department of Health & Human Services (HHS) announced the deadline for health insurers to submit applications to sell insurance in the states where the federal government is running health insurance exchanges has been extended by three days until this Friday.

Click here to read more.

White House: Cutting Medicare Will Only Shift Costs

Addressing the nation’s budget deficit by cutting Medicare will simply shift health care costs to the private sector and not address underlying issues, Obama administration officials said yesterday at a White House briefing. Health and Human Services (HHS) Secretary Kathleen Sebelius said Medicare and Medicaid are not the reason health costs are going up.

Click here to read more.

MedPAC Home Health Recommendations

Late last week, MedPAC released its annual report to Congress on payment policy. Below is a summary summary of recommendations for home health.  Stay tuned to the HMS Healthcare Management Solutions blog for the hospice recommendations later today.

Home Health Recommendations:

  • The Health & Human Services (HHS) Secretary, with the Office of the Inspector General (OIG), should conduct medical review activities in counties that have abnormal home health utilization. New authorities should be implemented to suspend payment and enrollment of new providers if they indicate significant fraud.
  • Congress should direct the HHS Secretary to begin a two-year rebasing of home health rates in 2013 and eliminate the market basket update for 2012.
  • The HHS Secretary should revise the home health case-mix system to rely on patient characteristics to set payment for therapy and non-therapy services and should no longer use the number of therapy visits as a payment factor.
  • Congress should direct the HHS Secretary to establish a per episode copay for home health episodes that are not preceded by hospitalization or post-acute care use.

OIG: SNFs Fail To Meet Requirements For Care, Discharge Planning

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released Skilled Nursing Facilities Often Fail to Meet Care Planning & Discharge Planning Requirements the latest in a series of studies examining Skilled Nursing Facility (SNF) payments and quality of care. The report found for 37% of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans.

Click here to read more.

Notable Changes To Final HIPAA Omnibus Rule

Among the more notable changes to the HIPAA Omnibus Final Rule recently released by the U.S. Department of Health & Human Services (HHS) is a new tiered penalty structure for covered entities in violation of the law.  Fines increase to as much as $50,000 for “willful neglect” of information without correction and $1.5 million for multiple violations of identical provisions.

Four other areas of the rule that will have a significant impact on providers are:

  • A change that makes business associates and their subcontractors liable for breaches of personal health information
  • An enhanced right for patients to obtain electronic copies of their records
  • An enhanced right for individuals to request restrictions regarding disclosure of their Protected Health Information (PHI)
  • A change to the breach notification rule in which any disclosure of PHI is presumed to be a breach

DOJ, HHS Recovered $4.2 Billion In FY 2012

HMS Healthcare Management SolutionsEarlier this week, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius released a new report showing that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. This reflects the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Control (HCFAC) Program.

Click here to read more.