Home Health & Hospice

Weekly roundup

Homecare Insider, July 11, 2016

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False claims penalties to double

Penalties for fraud by healthcare providers and others will soon likely double, according to an interim final rule published last week in the Federal Register. Penalties for each false claim submitted to Medicare and other government programs will rise to a minimum of $10,781 from the current minimum of $5,500 under the False Claims Act (FCA). The maximum would rise to $21,563 per claim from the current $11,000 cap. Since each FCA case can include a multitude of claims, the proposed increase could result in potential penalties in the millions and even billions of dollars, Modern Healthcare reported. 

According to the rule, penalties for violations of the Anti-Kickback law will also rise from $11,000 to $21,563. But the posture is worse than the punishment, according to experts, who acknowledge the increased penalties could lead more whistle-blowers to file lawsuits against providers they suspect of committing fraud. In successful FCA cases, whistle-blowers are entitled to a percentage of money the government is able to recover. In 2015, two-thirds of federal FCA lawsuits filed by whistle-blowers were aimed at healthcare entities.

However, the higher penalties won't necessarily result in providers having to actually pay more to settle such cases—they are often settled because providers don't want to risk having to pay the already-large penalties, on top of triple damages, sources told Modern Healthcare last week.

The civil penalty amounts outlined in the interim rule are applicable only to civil penalties assessed after August 1, whose associated violations occurred after November 2, 2015. Violations occurring on or before November 2, 2015, and assessments made prior to August 1, 2016, whose associated violations occurred after November 2, 2015, are subject to existing regulations for civil penalties.

Source: Modern Healthcare

Live boot camp on Home Health Coding, OASIS, and Quality

Join coding and OASIS expert Joan Usher, BS, RHIA, ACE, AHIMA-approved ICD-10-CM Trainer, for the Home Health Coding, OASIS, and Quality Boot Camp as she guides participants through lingering ICD-10 issues, OASIS documentation, value-based purchasing, documentation auditing, and star ratings. Earn ANCC credits while empowering yourself to tackle the most pressing challenges your agency faces. Learn more here.

The boot camp takes place July 18–19, 2016 at the Hyatt Place Chicago/Schaumburg Hotel in Chicago.

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CMS revises code for home health episodes with no skilled visits

CMS last week revised the condition code for home health episodes with no skilled visits to accommodate situations, such as an unexpected inpatient admission, where a home health agency (HHA) cannot deliver the skilled services planned for an episode.

Medicare systems are required to return to the provider any claims for episodes that are the first episode in a sequence of episodes or are the only episode of care received by a beneficiary for which a patient’s eligibility for the Medicare home health benefit has not been established. However, there may be circumstances that prevent the HHA from delivering the skilled services. 

The new code allows home health agencies to indicate that such documentation exists. The new condition code 54 is defined as “No skilled home health visits in billing period. Policy exception documented at the HHA.” Submission of this code will streamline claims processing for both the payer and provider. Claims without skilled visits that are submitted without the new condition code will be returned to the provider. This will allow the HHA to:

  • Add any accidentally omitted skilled services to the claim;
  • Submit the claim as noncovered, if appropriate; or
  • Append the new condition code.

CR9474 also addresses unintended consequences of new Healthcare Common Procedure Coding System (HCPCS) codes for skilled nursing visits.

The change was implemented July 5 and affects claims received on or after July 1. CR9474, the official instruction regarding this change, has been issued to Medicare Audit Contractors and is available at the CMS website.

Source: MLN Matters

Google takes substantial stake in Care.com

Care.com, the world’s largest online site for finding and managing care—including home health—announced last week that Google Capital, a growth equity fund backed by Alphabet Inc., has invested more than $46 million in the company. The move makes Google Capital the largest shareholder in Care.com.

Care.com, launched in 2007, connects care providers with those who need care. Today, the Waltham, Massachusetts-based company is the world’s largest online destination for finding and managing family care, with 11 million families and more than 8 million providers of all types of care for people of all ages as well as housekeeping and pet care.

Source: BusinessWire