Participate in this year’s HCAF Salary & Benefits Survey!

August 20, 2014

salary_survey Blinder

 

For several years now, HCAF has been conducting a salary and fringe benefit survey of the home health industry in Florida. It is our goal to continue helping providers understand how agencies around the state are compensating their employees in order to remain competitive when it comes to recruiting and maintaining staff.  HCAF does this by collecting the data through a secure excel toolkit. Read the rest of this entry »

CMS Announces its Next Home Health, Hospice and DME Open Door Forum – August 20

August 15, 2014

CMS has announced that its next Home Health, Hospice and DME Open Door Forum will be held next Wednesday, August 20. NAHC members are encouraged to note that some key issues will be addressed, including the revised hospice cost report for freestanding agencies.

The link that accompanied the announcement appears to be the second version of the cost report that was issued on November 22, 2013.  It is unclear whether these will be the actual, final cost report forms and instructions for freestanding agencies that CMS has indicated will be required for cost reporting years beginning October 1, 2014, and afterward, or if CMS will release another version that incorporates some of the additional changes that were recommended by the industry during December 2013.

Below is the tentative agenda for CMS Home Health, Hospice and DME Open Door Forum:

I. Opening Remarks

Chair – Randy Throndset, Center for Medicare

Moderator – Jill Darling (OC)

II.  Announcements & Updates

  •   OASIS-C1 webinar, September 3, 2014 @2PM, Survey and Certification letter attached.

§Can be found at: http://www​.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html search for OASIS-C1_ICD9

  • FY 2015 Hospice Payment Rate Update Final Rule

§ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/H​ospice/Hospice-Regulations-and-Notices-Items/CMS-1609-F.html

  • Hospice Cost Report

§  http: //www.reginfo.gov/public/do/PRAViewIC?ref_nbr=201312-0938-003&icID=8476

  • Hospice CAHPS Survey

§  http://www.hospicecahpss​urvey.org

  • HHCAHPS (Home Health CAHPS Survey)

§at URL https://homehealthcahps.org

III. Open Q&A

**Next Home Health, Hospice & DME ODF: October 1, 2014

Mailbox: HomeHealth_Hospice_DMEODF-L@cms.hhs.gov

———————————————————————

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-800-837-1935 & Reference Conference ID: 44421630.

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-855-859-2056; Conference ID: 44421630.

Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID beginning 2 hours after the call has ended. The recording expires after 2 business days.

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

 

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CMS Issues Several Change Requests Specific To Home Health Agencies

August 8, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued four Change Requests that provide guidance to the Medicare Administrative Contractors (MACs) on several home health policy and claims processing issues.

Change request 8699- Preventing Duplicate Payments When Overlapping Inpatient and Home Health Claims Are Received Out of Sequence

CMS has instructed the MACs to implement edits that will prevent home health claims from processing with dates of service that overlap an inpatient stay. In response to a 2012 Office of Inspector General report that exposed claim vulnerabilities, CMS has identified two conditions where a home health claim could process that overlap with an inpatient claim:

The edit that rejects home health claims when they have dates overlapping an inpatient stay – other than the admission date, discharge date, or a date during an occurrence span code 74 period indicating a leave of absence – does not consider inpatient stays in a swing bed (Type of Bill 018x), and

Medicare systems only identify overlaps with inpatient stays when the inpatient hospital or skilled nursing facility claim was received before the home health claim.

Effective January 1, 2015, If an HH Prospective Payment System (PPS) claim is received, and CWF finds dates of service on the home health claim that falls within the dates of an inpatient, SNF or swing bed claim – not including the dates of admission and discharge, and the dates of any leave of absence – Medicare systems will reject the home health claim. The HHA may submit a new claim removing any dates of service within the inpatient stay that were billed in error.

If the home health PPS claim is received first and the inpatient hospital, SNF or swing bed claim comes in later, but contains dates of service duplicating dates of service within the home health PPS episode period, Medicare systems will adjust the previously paid home health PPS claim to non-cover the duplicated dates of service.

For more on this change request, please click here.

Change Request 8710-PreventingPayment on Requests for Anticipated Payment (RAPs) When Home Health Beneficiaries are Enrolled in Medicare Advantage (MA) Plans

Current Medicare systems edit reject claims for home health episodes when a beneficiary is enrolled in a Medicare Advantage plan.  However, Requests for Anticipated Payment (RAPs) for such episodes are currently being paid.

Effective January 1, 2015, edits will be put n place to ensure that RAPs with “From” dates falling within Medicare Advantage enrollment periods are processed, but are paid at zero percent. If a final claim is received it will be rejected, as is currently the process.  Additionally, the requirements add remittance advice coding to zero-paid RAPs processed in Medicare Secondary Payer situations, so that the two situations can be distinguished. In the future, CMS will seek a new alert remittance advice remark code to specifically identify the Medicare Advantage cases also.

For more on this change request, please click here.

Change Request 8813- Diagnosis Reporting on Home Health Claims

Effective January 1, 2015, the MACs will implement edits to reject HH claims that list a manifestation code as a primary diagnosis.

An analysis of Outcome Assessment and Information Set (OASIS) records and claims for CY 2011 revealed that some agencies were not complying with the coding guidelines when reporting the primary diagnosis, in particular with regards to certain codes that require the underlying condition be sequenced first followed by the manifestation.

The principal diagnosis reported on the home health claim shall be the ICD-9-CM code that is most related to the current home health plan of care. HHAs shall not submit manifestation codes as the primary diagnosis.

For more on this change request, please click here.

Change Request 8818 -Clarification of the Confined to the Home Definition in Chapter 15, Covered Medical and Other Health Services, of the Medicare Benefit Policy Manual

In the calendar year 2012 Home Health PPS Final Rule published on November 4, 2011, CMS finalized its proposal to provide clarification to the Benefit Policy Manual language regarding the definition of a patient being “confined to the home.”

In October 2013, CMS issued change request 8444 to clarify the definition of “confined to the home” to more accurately reflect the definition articulated in Sections of 1814(a) and 1835(a) of the Social Security Act. At that time, chapter 2 of the Medicare Benefit Policy Manual was revised. Change request 8818 also updates chapter 15 of the Medicare Benefit Policy Manual to reflect the clarification of “confined to the home” definition.

For more on this change request, please click here.

Source: NAHC

 

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HCAF Celebrates 25 Years of Supporting the Home Health Industry at Its 2014 Annual Conference and Trade Show

July 25, 2014

This past week, HCAF was joined by over 700 members and guests for 6 days of fantastic educational workshops, a bustling trade-show with top-tier vendors and prize giveaways, increased motivation for advocacy efforts, and even a bit of fun at our 2014 Annual Conference and Trade Show.

Sandy Elsass of Ponce De Leon LTC RRG addresses the conference

Held in the Buena Vista Palace Hotel and Spa, attendees participated in over 65 educational sessions covering topics such as how to get more referrals, home health marketing, upcoming CMS changes, leadership skills, employment law, compliance, wound care, and much, much more. In addition, HCAF also offered ICD-9 and ICD-10 coding courses, as well as OASIS-C training and the COS-C Certification exam.

Attendees and vendors network at the Trade Show

In the Trade Show Hall, nearly 100 home health support companies displayed their services and showed attendees how they could help their agency’s succeed. Members and guests had the opportunity to have one-on-one meetings with these vendors who could be the partners that help their business reach their own silver anniversary and beyond. Our Trade Show had even more to offer than these wonderful networking opportunities: attendees walked away with incredible prize giveaways such as a 3 hour spa package, several iPads, a $300 gift certificate to Walt Disney World, and even $500 cash! Following the Trade Show, members and vendors headed up the scenic 20Seven lounge on the 27th floor of the hotel to take in panoramic views of Walt Disney World and the surrounding area, while they enjoyed beverages, heavy hors d’oeuvre, and chatted with other guests and vendors.

 

 

Rep. Castor Dentel speaks at the PAC Breakfast

Advocacy was also a large focus at this year’s conference, with many attendees being inspired by messages from HCAF Board President Anthony Clarizio and NAHC Vice President of Law Bill Dombi that we all need to do more to convince legislators of the importance of home health in the spectrum of patient care options. They stressed the value of the Home Care PAC, HCAF’s political arm that raises money to support the campaigns of legislators who have been home care heroes in the past. This year the PAC Raised over $7,000 to use in the 2014 election; more than tripling the amount of donations from the previous year. Some of these fundx were raised through the annual Home Care PAC Breakfast, where this year PAC members heard from Rep. Karen Castor Dentel (D-Maitland) about the importance of building relationships with legislators and how home health professionals could do so.

 

 

Hundreds of attendees pack the general session hall

In short, HCAF is thrilled to have had one of our most successful conferences ever and would like to thank everyone who joined us to celebrate our 25th anniversary. We would also like to thank our generous sponsors, Ponce De Leon LTC RRG, Hometown Homecare, Kinnser Software, and Axxess, as well as our other sponsors and our hardworking volunteers. We could not have pulled off such a great event without all of these great friends. We look forward to beginning to plan our 2015 Annual Conference and Trade Show and continuing to reach our golden anniversary and beyond!

 

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Owner and Administrator of Miami Home Health Companies Pleads Guilty for Role in $74 Million Health Care Fraud Scheme

July 25, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A Miami resident who owned a home health care company and was the administrator of another home health care company pleaded guilty today for her participation in a $74 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement.

Elsa Ruiz, 45, pleaded guilty today before U.S. District Judge Marcia G. Cooke in the Southern District of Florida to one count of conspiracy to commit health care fraud. Her sentencing is scheduled for Oct. 8, 2014.

According to court documents, Ruiz was an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care. Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care , as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.

From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

Source: OIG

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Submit Comments on CMS’s Proposed Rule on 2015 Home Health PPS!

July 18, 2014
With the recent release of the 2015 CMS Proposed Rule on the Home Health Prospective Payment System, it is incumbent on providers to submit comments to CMS about the rule during the 60 day commentary period. The 2015 proposed rule stands to make significant changes to the face-to-face process, therapy assessments, and much more. The home health industry has rarely submitted much more than 100-200 comments on each years proposed rule changes to the PPS. For an industry with over 12,000 nationwide Medicare providers, our voice must be louder!
John M. Reisinger of Innovative Financial Solutions for Home Health has provided HCAF with a bookmarked version of the 2015 proposed rule in the Federal Register in order to better understand it. If you would like additional explanation, HCAF will be hosting a webinar featuring John entitled, “The Proposed Rule for 2015″. Click here for more information.
Once you are more familiar with the rule, you can click here to submit a formal comment to CMS. Speaking up as an industry is the only way we can affect positive regulatory changes for the home health industry!
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Miami Patient Recruiter Pleads Guilty for Role in $6.5 Million Health Care Fraud Scheme

July 3, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A patient recruiter for a Miami home health care agency pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Nestor’s Health Services Inc. (Nestor HH). The owner and operator of Nestor HH pleaded guilty to charges related to the scheme earlier this month.

On June 27, 2014, Euridice Borroto, 45, of Miami, Florida, pleaded guilty before U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida to one count of conspiracy to solicit and receive health care kickbacks and to defraud the United States. Sentencing is scheduled for Aug. 25, 2014.

According to court documents, Borroto was paid bribes and kickbacks for recruiting patients on behalf of Nestor HH, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. The owner and operator of Nestor HH operated Nestor HH for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

According to court documents, Borroto solicited and received kickbacks and bribes from the owner and operator of Nestor HH in return for recruiting and providing patients to Nestor HH for home health care and therapy services that were medically unnecessary and, in many instances, were not provided. Nestor HH would then fraudulently bill the Medicare program for home health care services on behalf of the recruited patients, in violation of federal criminal laws. Borroto knew that in many instances the patients she recruited for Nestor HH did not qualify for the services billed to Medicare.

From approximately March 2009 through at least January 2014, Nestor HH submitted more than $6.5 million in claims for home health services. Medicare paid Nestor HH more than $6.1 million for these fraudulent claims before the fraud was exposed.

In documents filed with the court, Borroto also acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorneys Anne P. McNamara and A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: http://www.stopmedicarefraud.gov.

Office Worker Pleads Guilty in Miami to Role in $7 Million Health Care Fraud Scheme

June 20, 2014

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

An office worker pleaded guilty today in connection with a health care fraud scheme involving Anna Nursing Services Corp. (Anna Nursing), a defunct home health care company.

Lizette Garcia, 37, of Miami, Florida, pleaded guilty before U.S. District Judge Joan A. Lenard in the Southern District of Florida to one count of payment of health care kickbacks. Sentencing is scheduled for August 27, 2014.

Garcia was an office worker at Anna Nursing, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. According to court documents, Anna Nursing was operated for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were medically unnecessary and/or were not provided.

On behalf of the owners and operators of Anna Nursing, Garcia paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Anna Nursing for home health care and therapy services that were medically unnecessary and/or were not provided. Anna Nursing then billed the Medicare program on behalf of the recruited patients, which Garcia knew was in violation of federal criminal laws.

From approximately October 2010 through approximately April 2013, Anna Nursing was paid by Medicare approximately $7 million for fraudulent claims for home health care services that were medically unnecessary and/or were not provided.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorneys A. Brendan Stewart and Anne McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, has removed over 17,000 providers from the Medicare program since 2011.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov.

Annual Conference Preview: ICD-10 is Delayed. Are You Making the Mistake of Delaying Your Preparation?

June 6, 2014

WHY SOMEONE SHOULD ATTEND HCAF’s 2014 ANNUAL CONFERENCE AND TRADE SHOW:

Don’t miss Jennifer Warfield’s presentation, “Celebrating ICD-10: A New Tradition of Codes,” and learn how to maximize the extra ICD-10 preparation time for the survival of your agency.

The Senate’s recent vote to delay ICD-10 has taken the home health industry by storm and shock. With a new implementation date of Oct. 1, 2015, administrators, directors, CEOs and nurses now have been given a second chance to ensure their agency survives the transition. As we continue forward, it’s important for agencies to rethink their “preparation” game plan. This additional training time should not go to waste. ICD-10 cannot be delayed forever and should be viewed as a postponement, not an end.

Although agencies have spent countless hours, dollars and energy in proper preparation for the 2014 implementation and despite the delay, it is important to keep staff members up to date with continued ICD-10 education. This delay will allow coders (both seasoned and novices) more time to prepare, review processes and decide which training method will be the most effective. Keep in mind that coding correctly has more use and benefits than just getting the diagnoses correct on the OASIS. Correct codes are essential for accurate documentation and risk adjustment. Additionally, codes are used universally for data collection, research and developing best practices.

On-site and online ICD-10 training has become a significant source of education for numerous home health professionals nationwide. Most professionals who attend ICD-10 training courses, learn about the numerous, significant differences between ICD-10 and ICD-9 and fully understand how long it will take to become proficient in ICD-10 coding. Even the most seasoned ICD-9 coders have concerns and are glad that they started training early. These early trainees can attest to the fact that when considering that the new code set will now consist of approximately 70,000 codes, as opposed to the current 14,000 codes, finding the correct one will understandably require more time.

Now is the time to get your agency on the right track with proper preparation and education. There are many routes that agencies can take to assure that they are properly prepared for ICD-10, such as online educational webinars or a private on-site workshop. As PPS Plus Software’s education director, I have been crisscrossing the country, conducting ICD-10 training sessions for home health agencies and associations nationwide. Additionally, I am over halfway through a 9-part ICD-10 webinar series that I am conducting for PPS Plus Software, which began this past January and will wrap up in September of this year. To register for my next ICD-10 webinar, please do so by clicking here. Additionally, if you would like to request a private webinar or on-site workshop, please fill out the education request form here.

When we are finally given the green light to implement ICD-10, we can transition into ICD-10 with confidence, knowing we have utilized all the available educational resources to properly educate ourselves and become ICD-10 experts.

If you would like to learn how PPS Plus Software’s OASIS analysis software and team of coding experts can help you with ICD-9 and prepare for ICD-10, please call (888) 897-9136 or info@ppsplus.com. You can also visit PPS Plus Software’s website at www.ppsplus.com.

Registration for HCAF’s 2014 Annual Conference and Trade Show is open! Register today to attend great presentations from Jennifer Warfield and many other nationally recognized home care experts. Click here to go to our 2014 Conference Website

About PPS Plus Software

Find OASIS errors and clinical inconsistencies quickly and easily with PPS Plus Software’s industry-leading OASIS analysis software, featuring thousands of alerts to help you achieve clinical and financial accuracy. PPS Plus Software also offers exceptional benchmarking services, education and consulting services, coding and OASIS review services, as well as HHCAHPS services by Deyta.

©2014 Jennifer Warfield. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

Rebasing Relief Bill Introduced in the U.S. House of Representatives

May 16, 2014

Congressman Ralph Hall (R-TX) recently introduced the Medicare Home Health Rebasing Relief and Reassessment Act (H.R.4625). The bill seeks to suspend CMS’ flawed rebasing rule for 12 months and require that CMS reassess the rule and submit a report to Congress on alternative rebasing methods, including methods offered by stakeholders. 

The National Association of Home Care and Hospice and the Texas Association for Home Care & Hospice were involved in drafting the legislation and in getting H.R. 4625 introduced. HCAF has pushed for the passage of relief against these unfair and punitive across-the-board cuts to home health and supports this legislation.

In February, Rep. Hall – along with a bipartisan group of his colleagues – sent a letter to House Speaker John Boehner (R-OH) and House Minority Leader Nancy Pelosi (D-CA) urging congressional action to postpone CMS’ Final Rule on home health rebasing and require that CMS re-evaluate the rule.

The letter strongly reinforces the points that HCAF has been stressing since the beginning of the rebasing debate, namely that:

“If this rule is not postponed and appropriately evaluated, according to CMS projections almost half of the home health industry will be paid less than their costs. Current industry data shows that as many as 73% of home health agencies across the country could be out of business when the rule is fully implemented…

The Final Rule…clearly does not take into consideration the appeals made by the U.S. Congress and interested stakeholders. The Final Rule unnecessarily rebases payment rates at the maximum cut permitted under the Affordable Care Act: a cut of -3.5% per year over each of the next 4 years, totaling an unprecedented cut to Medicare home health funding of 14% by 2017…

Urgent action is needed as the Final Rule took effect January 1, 2014.Home health plays an essential role in our health care system by serving the Medicare population with skilled nursing and habilitation services in the least costly setting – the home, and it is imperative that we protect access to care through informed and reasonable rulemaking.”

The February letter outlines – and the legislation that was recently introduced would – provide relief from the rebasing rule while compelling CMS to look at alternative methods of rebasing. 

HCAF strongly encourages all of its members to take a moment to contact their Representatives in the House and ask that they cosponsor this important legislation.  It is especially important to get Democratic lawmakers to sign-on as a cosponsor to maintain a bipartisan balance.

For contact information, please click here.


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