Here are some home health related updates for this week:
Join Amity Healthcare Group and ACHCU as we review regulatory requirements associated with the competency program, as well as discuss the impact of an effective competency program on clinical personnel, patients, and leadership. We will also discuss what makes a successful competency program.
Next CMS Administrator is Confirmed
Home Health Notice of Admission (NOA)
As we discussed in our last newsletter, CMS will be replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission (NOA). On May 20, 2021 CMS issued a new MLN Matters Article MM12256 on replacing RAPs with NOAs.
The article covers updates to Chapter 10 of the Medicare Claims Processing Manual to include instructions for submitting Home Health (HH) NOAs instead of RAPs on and after January 1, 2022. Please make sure your billing staffs are aware of these manual updates.
OIG Home Health Claims Audit Report
The Office of Inspector General published an audit report that includes findings that Medicare improperly paid some claims for home health services with 5-7 visits in a payment episode. The primary objective of the audit was to determine whether payments for home health services with five to seven visits in a payment episode complied with Medicare requirements.
The audit covered $1.25 billion in Medicare payments to HHAs for claims for home health services provided in 2017 (audit period). OIG selected a random sample of 120 HHA claims with 5, 6, or 7 visits in a payment episode. An independent medical review contractor determined whether the services met medical necessity and coding requirements.
The OIG determined that not all payments to HHAs for home health services with five to seven visits in a payment episode complied with Medicare requirements. Of the 120 sampled claims OIG reviewed during the audit, 91 complied with requirements, and for 4 claims there was no documentation available to make a compliance determination. However, the remaining 25 claims did not comply with requirements. As a result, Medicare improperly paid HHAs for a portion of the payment episode (14 claims) and for the full payment episode (11 claims), totaling $41,613. According to OIG, “these improper payments occurred because the Medicare administrative contractors (MACs) did not analyze claim data or perform risk assessments to target for additional review those claims with visits slightly above the LUPA threshold of four visits. On the basis of the sample results, OIG estimated that Medicare overpaid HHAs nationwide $191.8 million for our audit period.”
Based on the findings, OIG recommends that CMS: (1) direct the MACs to recover the $41,613 in identified overpayments made to HHAs for the sampled claims; (2) require the MACs to perform data analysis and risk assessments of claims with visits slightly above the applicable LUPA threshold and target these claims for additional review; and (3) instruct the MACs to educate HHA providers on properly billing for home health services with visits slightly above the applicable LUPA threshold, which could have saved Medicare as much as $191.8 million during our audit period.
CMS concurred with all of the recommendations and established actions to be taken to address the recommendations.
For a complete report, please go to: https://www.oig.hhs.gov/oas/
Initial Due Date
Extended Due Date
American Rescue Plan of 2021-Impact on Home Health and Home Care
As a part of the American Rescue Plan Act (ARPA), the Department of Health Care Policy & Financing (the Department) expects to receive an additional infusion of short-term funds to increase access to home and community-based services (HCBS) and other long term support programs for Medicaid beneficiaries.
Per the guidance from the Centers for Medicaid and Medicare Services, in order to be eligible for these funds, the state must:
- Spend the state funds on HCBS-related services and infrastructure;
- Use the additional federal funds to supplement, not supplant, existing state funds expended for Medicaid HCBS in effect as of April 1, 2021;
- Use the state funds equivalent to the amount of federal funds attributable to the increased FMAP to implement, or supplement the implementation of, one or more activities to enhance, expand, or strengthen HCBS under the Medicaid program;
- Maintain provider payment rates;
- Maintain eligibility standards and preserve benefits covered as of April 1, 2021;
- Submit both an initial and quarterly HCBS spending plan and narrative to CMS on the activities that the state has implemented and/or intends to implement.
On May 27, 2021, HCPF held meetings for Long Term Home Health and PDN providers as well as HCBS providers to discuss eligible services, immediate planning, Joint Budget Committee Bill, federal guidance, fiscal impact, timelines, and proposed plan for the state of Colorado as related to ARPA.
Department of Regulatory Agencies- Rule Update
On May 25th, the Colorado Register published a rule update related to the required disclosure to patients of conviction of or discipline based on sexual misconduct. At this time, this rule update applies to Board of Nursing and State Physical Therapy Board.
The rule states that “on or after March 1, 2021, a health care provider subject to these Board of Nursing Rules shall disclose to a patient, as defined in section 12-30-115(1)(a), C.R.S.,
instances of sexual misconduct, including a conviction or guilty plea as set forth in section 12-30-115 (2)(a), C.R.S., or final agency action resulting in probation or limitation of the
provider’s ability to practice as set forth is section 12-30-115(2)(b), C.R.S.”
Please see attached documents for a complete rule.
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Irina Gorovaya, RN BSN, MBA
Amity Healthcare Group, LLC
Home Health Consulting, Education and Outsourcing Services
720-353-7249 (cell) 303-690-2749 (office) 720-398-6200 (fax)