Category: Payment/economy

CMS forum provides noteworthy updates about HEART and quality reporting training

Brought to you by Home Health Line. To address concerns raised during pilot testing for its planned comprehensive hospice assessment tool, CMS has decided to delay further testing phases. But CMS is working diligently to retool the Hospice Evaluation and Assessment Reporting Tool (HEART) and plans to hold quarterly special open door forums beginning in […]

CMS to discuss proposed PPS rule during upcoming home health forum

Brought to you by Home Health Line. CMS has scheduled a home health, hospice and durable medical equipment open door forum for 2 p.m. to 3 p.m. EST July 11. During the call, CMS officials will discuss the proposed 2019 PPS rule for home health and make announcements related to the home health and hospice […]

MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

Brought to you by Home Health Line. Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC). But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto […]

AMA calls for funding of long-term care and support

The American Medical Association (AMA) announced during its 2018 annual meeting that it recognized the growing importance of long-term services and supports (LTSS). In 2015, national spending for LTSS exceeded $331 billion, more than half of which was funded by Medicaid. According to AMA Board Member Stephen R. Permut, MD, JD, “Rising costs of everything […]

Reimbursement increased by 77% for brand-name Part D drugs

Brought to you by BALTC. According to a report published by the OIG this month, total reimbursement for all brand-name drugs in Part D increased 77% from 2011 to 2015, despite a 17% decrease in the number of prescriptions for these drugs. After accounting for manufacturer rebates, reimbursement for brand-name drugs in Part D was […]

CMS asks Medicare insurance providers to monitor prescriptions of Neudexta

CMS is warning insurance providers to watch prescriptions of Neudexta for off-label use. Neudexta is a prescription meant to treat symptoms of pseudobulbar affect (PBA), which can cause uncontrollable laughter or crying. As CNN reports, prescribing for off-label use is not illegal, but creating a false diagnosis in order to secure coverage of the prescription […]

CMS proposes to resume pre-claim demo, potentially expand it to more states

Brought to you by Home Health Line. CMS is seeking public input into relaunching a pre-claim review demonstration for home health services. States that are potentially affected are located within the Medicare Administrative Contractor (MAC) Palmetto GBA’s jurisdiction. “CMS proposes initially implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas with the option […]

CMS outlines some soon-to-be covered services in memo on Medicare Advantage

Brought to you by Home Health Line. In-home support services and adult day care services are on the list of supplemental benefits to be allowed under Medicare Advantage plans in 2019, according to a recent CMS memo. Home-based palliative care, support for caregivers of enrollees, medically-approved non-opioid pain management, stand-alone memory fitness benefit, home bathroom […]