News Alerts
CMS RELEASES FINAL HOSPICE RATE UPDATE
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 ...
DEACTIVATION OF MEDICARE BILLING PRIVILEGES DUE TO LACK OF BILLING
Volume 22.06
For several years we have cautioned health care providers that Medicare billing privileges could be deactivated if the provider did not submit any Medicare claims for twelve (12) consecutive months. This deactivation is ...
HOSPICE ELECTION TO PARTICIPATE IN CMS PART D AND HOSPICE ELECTION PILOT PROGRAM
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, ...
HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM FY 2021 REPORT ISSUED
Volume 22.05
The Department of Health and Human Services and the Department of Justice have released the Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2021.
During FY 2021, the federal government won or ...
CMS PROPOSES TO REDUCE NATIONAL STANDARDIZED 30-DAY PERIOD PAYMENT
Volume 22.03
The Centers for Medicare & Medicaid Services (“CMS”) has released the Proposed Rule, “Medicare Program; Calendar Year (CY) 2023 Home Health Prospective Payment Rate Update; Home Health Quality Reporting Requirements; Home ...
ASSESSING THE IMPACT OF CAP RECOMMENDATIONS BY MEDPAC
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 Alert 22.10
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 ...
Hospice Alert 22.09
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 ...
HOSPICE CAP LIABILITY AND CLAIM DENIALS
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 ...
COVID-19 PHE EXTENDED AGAIN
Volume 22.04
The Biden administration on Wednesday extended the COVID-19 public health emergency that had been due to expire on April 16. The 90-day extension, announced by the Department of Health and Human Services (HHS), will allow ...
CMS RELEASES PROPOSED 2023 PAYMENT UPDATE
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 ...
MedPAC REPORT RECOMMENDS REDUCTION IN HOME HEALTH PAYMENTS
Volume 22.02
The Medicare Payment Advisory Commission (“MedPAC”) made two recommendations to Congress in their recent Report. These are as follows:
“Our review of payment adequacy for Medicare home health services indicates that access ...
PRESIDENT SIGNS OMNIBUS SPENDING BILL
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 ...
MEDICARE PAYMENT ADVISORY COMMISSION (“MedPAC”) ISSUES MARCH 2022 REPORT TO CONGRESS
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 ...
REPORTING FOR USE OF PROVIDER RELIEF FUNDS
Volume 22.03
Many providers are confused regarding the required reporting for the use of Provider Relief Funds (“PRF”). Reporting timelines are based on when the funds were received by the provider. The following summarizes when funds must ...
Hospice Alert 22.04
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 ...
CMS MAKES MINOR CHANGES TO HOSPICE COST REPORT
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 ...
SELF-DETERMINED HOSPICE CAP OVERPAYMENTS
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 ...
CHANGING HEALTHCARE COSTS AS A RESULT OF COVID-19 PHE AND THE AFTERMATH
Volume 22.02
Many healthcare providers, consultants to the healthcare industry, and other observers have been attempting to gain an understanding of the changes to the healthcare delivery systems and the changes in costs incurred by ...
CMS UPDATES THE MEDICARE PROGRAM INTEGRITY MANUAL TO ADDRESS NOA
Volume 22.01
Home health agencies no longer submit Requests for Anticipated Payment (“RAP”) at the start of a home health episode of care. Effective January 1, 2022, agencies submit a Notice of Admission (“NOA”). The Manual has been ...
MEDPAC AND HOSPICE CAP REDUCTION RECOMMENDATIONS
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 ...
SUPREME COURT ALLOWS MANDATORY VACCINATIONS FOR HEALTH CARE PROVIDERS
Volume 22.01
On Thursday, the Supreme Court issued mixed rulings, allowing vaccine mandates for certain health care workers (Vote was 5-4), but blocking enforcement of a mandate for businesses with 100 or more employers (Vote was ...
READY FOR CAP REPORTING?
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 ...
MEDICARE SEQUESTRATION DELAYED AND REDUCED IN LEGISLATION
Volume 21.15
The U.S. Senate is expected to pass legislation (already passed in the House of Representatives) that would:
Implement an additional three (3) month suspension of the two percent (2%) Medicare sequestration payment ...
OIG REPORTS ON PALMETTO GBA, LLC CAP MANAGEMENT
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 ...
CMS ISSUES EMERGENCY REGULATION REQUIRING COVID-19 VACCINATIONS
Volume 21.14
CMS is issuing an Interim Final Rule requiring most Medicare and Medicaid certified providers and suppliers to establish a policy ensuring that all eligible staff have received the first dose of a two-dose vaccine or a one-dose ...
HOME HEALTH PAYMENT RATES FINALIZED
Volume 21.07
CMS has finalized 2022 home health reimbursement rates. Standard rates have increased by a net 2.6%, which is the result of an inflation update of 3.1% reduced by a .5% productivity adjustment.
The base 30-day rate increased ...
PROVIDER RELIEF FUNDS – PHASE 4 APPLICATION SUBMISSION TIMING MODIFIED
Volume 21.13
Over the weekend, the Health Resources and Services Administration (“HRSA”) modified certain details regarding the Phase 4 PRF application. Information provided by HRSA now requires Phase 4 applicants to submit their Taxpayer ...
PHASE 4 OF PROVIDER RELIEF FUNDING REQUIRES AN IRS VALIDATION
Volume 21.12
If you are going to apply for Phase 4 funding of Provider Relief Funds and have not yet applied for IRS validation, you should immediately submit required, but limited, information for IRS validation. This process must be ...
PROVIDER RELIEF FUND (PHASE 4) UPDATE
Volume 21.11
Providers can apply for the new, Phase 4, Provider Relief Funds beginning September 29, 2021. The application period will run through October 26, 2021. The application will be made in the Provider Relief Application and ...
CAP HOSPICES NEED TO EXERCISE CAUTION IN REPORTING REVENUES TO SUPPORT THE USE OF PRF FUNDS
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 ...
USING YOUR BUDGET FOR CALCULATING LOST REVENUES FOR PRF REPORTING
Volume 21.10
Three methods are available to healthcare providers for determining lost revenues eligible to be applied as a qualified use of Provider Relief Funds. These are:
Option 1: Actual 2020 and 2021 revenues compared against 2019 ...
PHASE 4 COVID-19 PHE PROVIDER FUNDING
Volume 21.06
HHS Press Release:
“The Biden-Harris Administration announced today that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new ...
WILL ALL HEALTH CARE PROVIDERS BE REQUIRED TO MANDATE COVID VACCINATIONS?
Volume 21.05
It is reported that the U.S. Centers for Medicare & Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) are jointly involved in the development of changes in Conditions of Participation that ...
NAHC CANCELS 2021 HOME CARE AND HOSPICE CONFERENCE AND EXPO
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 ...
AT HOME COVID-19 VACCINATION REIMBURSEMENT INCREASED
Volume 21.05
CMS has increased reimbursement to providers for in-home COVID-19 vaccinations as part of the efforts to provide opportunities for individuals who cannot leave their home, as well as increase the number of vaccinated persons. ...
2021 HOSPICE FINANCIAL MANAGEMENT ACADEMY
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 ...
2022 HOSPICE PAYMENT RULE RELEASED
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 ...
RULES FOR SINGLE AUDITS OF NONFEDERAL ENTITIES UPDATED TO ADDRESS PRF
Volume 21.04
The Department of Health and Human Services (“HHS”) has updated the rules relating to the reporting of Provider Relief Funds (“PRF”) use by nonfederal entities as part of the single audit requirements.
Recipients that expend ...
RULES FOR SINGLE AUDITS OF NONFEDERAL ENTITIES UPDATED TO ADDRESS PRF
Volume 21.09
The Department of Health and Human Services (“HHS”) has updated the rules relating to the reporting of Provider Relief Funds (“PRF”) use by nonfederal entities as part of the single audit requirements.
Recipients that expend ...
HOSPICE MERGERS AND ACQUISITIONS CONTINUE AT RAPID PACE
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 ...
HOSPICE FINANCIAL MANAGEMENT ACADEMY UPDATE (ROOM BLOCK AND REGISTRATION)
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 ...
COULD YOUR HOSPICE OVERPAY A CAP LIABILITY?
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 ...
MEDICARE ENROLLMENT UPDATES
Volume 21.08
CMS has temporarily ceased revalidations for Medicare providers and suppliers because of the COVID-19 PHE. CMS is not issuing any revalidation notices, deactivating providers for any failure to respond to revalidation requests ...
HHS REVISES REPORTING REQUIREMENTS FOR PROVIDER RELIEF FUNDS
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 ...
LONG AWAITED UPDATES TO PRF REPORTING DATES
Volume 21.07
The U.S. Department of Health and Human Services (“HHS”) has released updated reporting requirements for the use of Provider Relief Funds (“PRF”).
The period of availability of funds is based on the date the payment is ...
2021 NAHC FINANCIAL MANAGEMENT CONFERENCE
Volume 21.03
Registration is now officially open for the 2021 Financial Management Conference (FMC 2021), the only conference designed specifically for financial professionals in the industry. FMC 2021 is where future leaders build their ...
HOME HEALTH AGENCIES DEALING WITH NEW COST REPORTING FORMS
Volume 21.02
The U.S. Centers for Medicare & Medicaid Services (“CMS”) have significantly revised the Home Health Agency Cost Report, now identified as Form 1728-20. The new form is to be used for all cost reporting periods beginning on ...
ADVANCE CONFERENCE PROGRAM AVAILABLE
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. ...
CMS PROPOSES CHANGE IN LABOR COMPONENT OF HOSPICE RATES
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 ...