Home Health & Hospice

The Weekly Roundup

Homecare Insider, August 31, 2015

The National Association for Home Care and Hospice (NAHC) released a draft Friday of its comments on two key provisions of the proposed home health PPS rule for calendar year 2016. The trade association’s recommendations include withdrawing the steep case mix weight adjustments proposed for the next two years and reducing the percentage of payment at stake in the value based purchasing (VBP) program planned for the setting. Click here to access NAHC’s full set of analyses and recommendations on home health case mix weights and VBP.
CMS recently limited the scope of contractor review on certain claim denial appeals. Historically, the discretion granted to Medicare Administrative Contractors (MAC) and Qualified Independent Contractors (QIC) while conducting appeal reviews has allowed them to identify new reasons to support a denial that weren’t the basis for the original denial and subsequent appeal—an authority that can result in unfavorable appeal outcomes for providers. To curb this occurrence, CMS has issued a clarification that, for redeterminations and reconsiderations of claims denied following a post-payment review or audit, MACs and QICs must limit their evaluation to the reason(s) the claim or line item at issue was initially denied. This directive applies to appeal requests received by MACs and QICs on or after August 1, 2015. Click here to read the full MLN Matters article on the recent clarification.
Medicare accountable care organizations saved the federal government more than $411 million in 2014, according to a CMS report released last Tuesday on the performance of 20 Pioneer and 333 Medicare Shared Savings ACOs. Click here to read the full report.