Volume 23.09 The Consolidated Appropriations Act (CAA) of 2021 authorized the Secretary of Health & Human Services to create a Special Focus Program (SFP) which aims to address issues that place hospice beneficiaries at risk for poor quality of care through...
Volume 23.08 The 2024 Proposed Hospice Rule is only one indicator of the increased focus by CMS and federal legislators on hospice program integrity. CMS, in the 2024 Proposed Rule, has reported significant information regarding hospice utilization trends and other...
Volume 23.07 The U.S. Department of Health and Human Services (“DHHS”) is releasing information on the ownership of over 6,000 hospices and 11,0000 home health agencies certified to participate in the Medicare program on the Centers for Medicare & Medicaid...
Volume 23.06 On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services issued the proposed rule, Medicare Program; FY 2024 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice Quality Reporting Program...
Volume 23.05 According to the March Report to Congress, “Based on the generally positive indicators of payment adequacy and strong margins, the Commission concludes that a reduction to aggregate payments is warranted. However, in this sector, with the range of...
Volume 23.04 There is substantial confusion regarding when overpayments determined by self-determined CAP liability filings are required to be paid. The regulations are clear that any CAP liability determined by self-filing is due at the time of filing; however, in...
Volume 23.03 It is not too early to plan for and schedule your educational plan for 2023. As the COVID-19 Public Health Emergency comes to an end, many regulatory changes are already occurring and many more are forthcoming. Additionally, as integrity issues take...
Volume 23.02 Revisions to Appendix M of the CMS State Operations Manual have been released. The revisions are effective immediately; however, state survey directors have thirty (30) days to communicate the changes. State surveyors and accrediting organizations must...
Volume 23.01 The Fiscal Year 2023 Appropriations Bill (“Omnibus Budget”) recently passed includes the following of immediate interest to hospice providers: Sequestration – The legislation extends Medicare sequestration into 2032 and sets the sequestration at two...
Volume 22.17 All hospice providers need to be vocal regarding any efforts that Congress may take to reduce the Medicare CAP as part of any end-of-year legislative package. The National Association for Home Care and Hospice (“NAHC”) has created a simple email for you...
Volume 22.16 Many providers received Phase 4 funding (payment received between July 1, 2021, and December 31, 2021) of more than $10,000. These funds are used for lost revenues and qualifying COVID-19 expenses incurred between January 1, 2020, through December 31,...
Volume 22.15 FY 2023 hospice payment rates, effective October 1, 2023, have been set. Routine home care rates are as follows, before any wage index adjustment based on the location of the patient: FY 2023 Hospice RHC Payment Rates Code Description ...
Volume 22.15 We are very excited as we finalize our plans for the upcoming 2022 Hospice Financial Management Academy to be held on September 19-20, 2022. We are thrilled to be back at the Hotel Monteleone in New Orleans and look forward to seeing many clients and...
Volume 22.14 Recently, the United States Court of Appeals for the Ninth Circuit ruled that the way Medicare payments and sequestration was being handled when a hospice exceeds the hospice CAP was appropriate. The Health Group, LLC has previously reported that the...
Volume 22.13 The U.S. Centers for Medicare & Medicaid Services (“CMS”) has released the final rule updating the Medicare hospice payment rates and aggregate CAP amount for FY 2023, which begins on October 1, 2022. The FY 2023 hospice payment update percentage is...
Volume 22.12 Hospices can sign-up to participate in the CMS Part D and Hospice Election Pilot Program through July 31, 2022. The primary focus of the Pilot Program is the acceleration of communications and notifications between the Hospice, Medicare Part D Plans, and...
Volume 22.11 The Health Group, LLC constantly monitors recommendations of the Medicare Payment Advisory Commission (“MedPAC”) to Congress. A significant recommendation of MedPAC relating to hospice reimbursement is to reduce the Medicare hospice CAP by twenty percent...
IRS INCREASES ALLOWABLE MILEAGE REIMBURSEMENT Effective July 1, 2022, the standard mileage rate for business travel has been increased to 62.5 cents per mile, an increase of 4 cents from the current allowable reimbursement rate. This increase, mid-year, is in...
Volume 22.09 CLARITY IN CAP LIABILITY PROVISIONS OF PURCHASE AGREEMENTS As more hospices exceed hospice aggregate payment limitations (“CAP”) and hospice acquisitions continue at a rapid pace, we are constantly becoming involved in disputes between the Buyer and the...
Volume 22.08 As hospices become subjected to claims denials, whether such denials are the result of a UPIC or not, the hospice may be entitled to a refund of previously paid CAP liabilities. We reported on this in 2021; however, The Health Group, LLC ("THG") recently...
Volume 22.07 Yesterday, March 30, 2022, CMS issued the proposed rule that would update Medicare hospice payment rates and the aggregate payment limitation (“CAP”) effective October 1, 2022. 2022-07030.pdf (federalregister.gov). The proposed rate increase in Medicare...
Volume 22.06 Last week President Biden signed into law a $1.5 trillion spending package, referred to as an “Omnibus Spending Bill”. The legislation will fund the government through September 2022. The Bill also provides significant financial assistance to Ukraine....
Volume 22.05 MedPAC has released its March 2022 Report (“Report”) to Congress. As expected, MedPAC has again recommended hospices not receive any payment update in 2023 and that the aggregate payment limitation (“CAP”) be wage adjusted and reduced by an arbitrary 20%...
Volume 22.04 TECHNICAL CORRECTION Our last Hospice Alert (Volume 22.03) indicated that CMS revised the Hospice Cost & Data Report on September 25, 2022. The actual date of the revision was February 25, 2022, and is available here. HOSPICE CAP OBSERVATIONS...
Volume 22.03 On September 25, 2022, CMS revised the Hospice Cost & Data Report to add a new non-reimbursable cost center to accumulate costs associated with suicide accomplished with aid of a physician in those states that allow assisted suicide. Federal funds...
Volume 22.02 According to MedPAC, almost 20% of all hospice providers are now exceeding the Medicare aggregate payment limitation (“CAP”). Many hospices will have a CAP liability when they file their self-determined CAP liability report on or before February 28,...
Volume 22.01 The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. In addition to advising the...
Volume 21.17 Medicare- certified hospices are required to self-report the calculated aggregate payment limitation (“CAP”) no earlier than three (3) months after, and no later than five (5) months after the end of the hospice CAP Year. The 2021 CAP Year runs from...
Volume 21.16 The U.S. Department of Health & Human Services (“DHHS”) Office of Inspector General (“OIG”) issued a Report in July 2021 regarding the CAP management process of Palmetto GBA, LLC (“Palmetto”). Palmetto was selected from the Medicare Administrative...
Volume 21.15 Many hospices incur CAP liabilities, which must be repaid to the Medicare program. Information provided by HRSA regarding lost revenues does not specifically address CAP overpayments; however, HRSA Q&A includes the following: “Provider Relief Fund...
Volume 21.14 Yesterday the National Association for Home Care & Hospice announced the cancellation of the upcoming 2021 Home Care and Hospice Conference and Expo, which was scheduled for October 3-5, 2021, in New Orleans. “This was a very difficult decision to...
Volume 21.13 We are very excited to be sponsoring our Hospice Financial Management Academy live again. The 2021 program will be held at the Paris Hotel and Casino in Las Vegas on September 13-14, 2021. The response to this program has been tremendous. Based on...
Volume 21.12 CMS has issued the final rule, “Medicare Program; FY 2022 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program Requirements”. This final rule: Updates the hospice wage...
Volume 21.11 Hospices continue to lead the healthcare sector in investor interest and valuation even during the COVID-19 PHE. The price of hospices continues to rise due to the continually increasing demand and return opportunities expected for the next few years....
Volume 21.10 The early response to our Hospice Financial Management Academy, scheduled for September 13-14, 2021, has been overwhelming. We have ten (10) remaining spots available for the program (we limit attendance to maximize the benefit of the program). Early...
Volume 21.09 Recently, we have identified another hospice that has overpaid its CAP liability. This happens when a hospice has claims denied and is also subject to CAP overpayments. When a claim is retroactively denied for a completed CAP Year, the denied claims...
Volume 21.08 On June 11, 2021, the U.S. Department of Health and Human Services (“HHS”) revised the reporting requirements for Provider Relief Funds (“PRF”). Key updates include: The period of availability of funds is based on the date the payment is received (rather...
Volume 21.07 The Advance Conference Program and registration information for our upcoming Hospice Financial Management Academy is now available. The program will be held at the Paris Las Vegas Hotel & Casino on September 13-14, 2021. Early registration discounts...
As part of the FY 2022 Hospice Payment Rate Update CMS is proposing to modify the labor component for each of the daily reimbursement rates. The labor component is the basis for adjusting payment rates based on the location where the hospice services are furnished....
Volume 21.05 The Centers for Medicare & Medicaid Services (“CMS”) has issued the Proposed Rule, Medicare Program; FY 2022 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program...
Volume 21.04 This week Ryan Lindsay, CPA, Director at The Health Group, LLC, spoke at the Annual Meeting of the National Hospice & Palliative Care Organization (“NHPCO”). His presentation, “Amazon Will Change How Hospices Do Business”, was reported on by Hospice...
Volume 21.03 The Medicare Payment and Advisory Commission (“MedPAC”) recently recommended that “For fiscal year 2022, the Congress should eliminate the update to the 2021 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by...
Volume 21.02 After preparing substantial numbers of self-determined CAP Report filings for the 2020 CAP Year and CAP liability assessment reports for hospices across the country, it is increasingly obvious to us that greater numbers of hospices are exceeding hospice...
Volume 21.01 We continually receive questions regarding Medicare enrollment revalidations. CMS has temporarily ceased revalidation efforts for all Medicare providers or suppliers. During the public health emergency, CMS will not issue any new revalidation notices,...
Volume 20.16 At the recent meeting of the Medicare Payment Advisory Commission (“MedPAC”), the matter of wage adjusting the Medicare Aggregate Payment Limitation (“CAP”) and reducing the CAP by an arbitrary 20% was again discussed as MedPAC moves toward making its...
Volume 20.15 On September 14, 2020, CMS released Medicaid payment rates for FY 2021 (beginning October 1, 2020). The Medicaid hospice payment rates are calculated based on the annual hospice rates established under Medicare. These rates are authorized by section...
Volume 20.14 On July 31, 2020, the U.S. Centers for Medicare & Medicaid Services (“CMS”) released the final FY2021 hospice payment rule (“Rule”). The national hospice payment rates, subject to geographical application, and the hospice CAP will increase by 2.4%...
Volume 20.13 The Hospice Cost & Data Report (“Cost Report”) was substantially modified in 2014 to facilitate the accumulation of hospice costs by level of care (“LOC”), as well as capture other information, which can be used in establishing Medicare reimbursement...
Volume 20.11 In support of the Provider Relief Funding received by hospices, COVID-19 PHE incremental expenses incurred are now required reporting on a quarterly basis. These expenses, as well as lost revenues, will be reported as a use of the Provider Relief...
Volume 20.10 The National Hospice and Palliative Care Organization (“NHPCO”) is offering a webinar intended to address the legal, accounting, and financial reporting aspects of the PPP SBA Guaranteed Loan Program and the Provider Relief Funding, as well as the...