Tag: payment

Home health agency to pay $2.1 million in DOJ settlement

A home health agency has paid $2.1 million to settle claims of improper billing for services provided to patients in Florida, according to an announcement May 5, 2022, by the U.S. Attorney’s Office in the Western District of Kentucky, where the agency is headquartered. According to a complaint filed in the United States District Court […]

NOA discharge error resolved, reports NGS

NGS, a Medicare administrative contractor serving agencies in 19 states, reports to its providers that there has been a resolution for the months-long issue with Notices of Admission that was causing a return to provider incorrectly with edit code U537F. The error was due to the Common Working File not correctly recognizing discharges, according to […]

CMS will pay for second COVID-19 booster for patients

CMS announced April 6, 2022, that it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna vaccines. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least four months ago are eligible for another booster to increase their protection against severe disease […]

CMS releases 2023 hospice proposed rule

Hospice providers will have to wait a little longer for the Hospice Outcomes Patient Evaluation (HOPE) tool, according to the proposed rule for the FY 2023 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. The proposed rule was released on Wednesday, March 30, 2022, for public inspection and is expected to […]

CMS encouraging booster shots for beneficiaries

People with Medicare should get a booster shot of the COVID-19 vaccine, says CMS officials in a news release Dec. 2, 2021. CMS noted it is sending a letter to Medicare beneficiaries encouraging them to get a booster shot as soon as possible. They’re also rolling out reminders through advertising campaigns and telephone and email […]

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 […]