Tag: payment

Guidance for MACs expected to address payment error

CMS recently published a new change request to provide Medicare Administrative Contractors (MACs) with guidance on new LUPA add-on amounts for occupational therapy visits under new regulations in the home health final rule. The change request also addresses system issues with the payment grouper process. With the start of PDGM in 2020, all home health […]

CMS clarifies medical review requirements for new hospice election statement addendum

A new transmittal to MACs issued Oct. 21, 2021, notes the manual updates for clarification on the election statement addendum requirements. Key among the changes included in the hospice rule that went into effect Oct. 1, 2021: Hospices have five days to furnish the addendum if requested within the first five days of the effective […]

Deadline for home health proposed rule comments Aug. 27

Agencies and stakeholders have until Friday, August 27, to provide comments on the 2022 Home Health final rule. Formal comments can be submitted online. Introduced in late June, the proposed rule: Plots a national expansion for the Home Health Value-Based Purchasing (HHVBP) model in 2022 Sets a date for OASIS-E implementation: January 1, 2023 Increases […]

Home health agency settles overtime complaint for $85,000

A western Massachusetts home health agency will pay more than $85,000, including $77,000 in restitution to 79 employees, to settles allegations that the company failed to pay workers for travel time, according to a June 14 news release from Mass. Attorney General Maura Healey. The AG’s office issued two citations against Compassionate Healthcare Systems LLC […]

MACs announce fix for HIPPS code payment error

Medicare Administrative Contractors (MACs) have addressed a payment error impacting some claims that were tied to the generic HIPPS code used on RAPs. The HIPPS code on the RAP is only used by the CMS system to pair RAPs with the final claim. Under PDGM, the CMS payment system is expected to determine the actual […]

Agency to pay $140,000 after overtime lawsuit from DOL

A Pennsylvania home health agency will pay $66,000 in back wages and an equal amount in liquidated damages to 98 registered nurses and licensed practical nurses after an investigation by the U.S. Department of Labor noted a failure to pay overtime wages, including payment for ancillary work and work-related travel, according to a DOL news […]

Virtual Summit: Post-Acute NOW discusses rebalancing PDPM post-COVID

What will the new normal look like as the pandemic turns a corner? Skilled nursing facilities (SNFs) need to understand how payment was unique during the pandemic and how reimbursement might change moving forward. Understand what your SNF should be prepared for and how to look at the data to determine payment in the future. […]

CMS increases Medicare payment for COVID-19 monoclonal antibody infusions at home

CMS has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, health care facility or at home, CMS states in the […]

Latest RAP-related claims error involves placeholder HIPPS code

Some agencies are facing new payment issues related to the no-pay RAPs that began January 1, 2021. MACs Palmetto GBA and CGS, collectively responsible for claims in 31 states, have recently alerted agencies to a potential issue where Medicare’s system is sometimes not replacing the placeholder HIPPS code used to match RAPs and final claims. […]

Legislation would delay 2% Medicare sequestration payment reductions

The Medicare Sequester COVID Moratorium Act, H.R. 8840 legislation, was introduced by Reps. Brad Schneider, D-Ill., and David McKinley , R-W.Va., “to extend the suspension of the two percent Medicare sequestration payment reductions through the COVID-19 public health emergency (PHE),” according to a December 3, 2020, National Hospice and Palliative Care Organization (NHPCO) press release. […]