Archive for October, 2012

October 29, 2012

Settlement could affect Medicare coverage with HHAs

We don’t know when changes might happen, but this could help HHAs.

Settlement Eases Rules for Some Medicare Patients

… In a proposed settlement of a nationwide class-action lawsuit, the Obama administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve….

October 23, 2012

DH, NAHC alliance will include SHA

I have worked with DecisionHealth for many years across many education venues. This is an exciting opportunity for DecisionHealth and NAHC.

The alliance on education and communication also benefits Selman-Holman Associates! We will be providing ICD-10 education.

Here is some information on the NAHC-DecisionHealth alliance.

WASHINGTON D.C., October 23, 2012— Members of the National Association for Homecare and Hospice (NAHC) will see enhancements to their member benefits in 2013 as a result of a strategic alliance between NAHC and DecisionHealth.

“I am very pleased to announce this alliance with DecisionHealth, a company that has a long and distinguished record in our industry,” said NAHC President Val J. Halamandaris. “This partnership provides an efficient way for us to continue to enhance the depth and breadth of our member benefits while freeing resources to focus further on advocacy.”

Mr. Halamandaris added that the new affiliation covers a broad range of efforts to benefit homecare agencies and hospices, including jointly-produced live events, collaboration on ICD-10 training and education, and preferred discounts for NAHC members on DecisionHealth coding and compliance tools and guidance. The two organizations will also collaborate on offering certification and other professional development programs.

“All of us at DecisionHealth are proud to work with NAHC, the premier advocacy organization for the homecare and hospice community,” said Steve Greenberg, President of DecisionHealth. “We look forward to best-of-breed programs and services that result from our shared expertise and deep understanding of the home care market needs.”

Additional details announced today include:

  • NAHC’s Private Duty Homecare Association of America will collaborate with DecisionHealth to jointly sponsor two conferences next year for leaders of private duty agencies.
  • DecisionHealth will offer discounts for NAHC members on its core coding and compliance products, and its most venerable and longstanding newsletters, Home Health Line and Private Duty Insider.  The latter will expand its coverage to include valuable input from NAHC’s Private Duty Homecare Association of America.
  • The two organizations will launch a series of Home Care ICD-10 Readiness Seminars. These live training events will be designed to assist HHAs with strategic, operational and financial planning to assure seamless transition toward the October 2014 ICD-10-CM mandate.
October 21, 2012

Procedure coding is no longer required

Question: I recently attended your conference you advised us about procedure coding–that it was no longer necessary to report them as CMS does not count that. Did I understand this correctly??

Lisa says: Procedure coding is no longer required as of 4/20/2011. M1012 must still be answered but you may answer NA or UK on everyone if you’d like. There is also no requirement for surgical procedures on the POC.

October 17, 2012

OIG focus on Medicaid

This is the second post on the OIG’s FY 2013 work plan. The first post dealt with Medicare-related issues. This post looks at HHA focuses for Medicaid issues. Note that some have a FY2014 start date. This can indicate a new focus on an item that is already being watched by OIG.

Duplicate Payments by Medicare and Medicaid: OIG will review Medicaid payments by states for Medicare-covered home health services to determine the extent to which both Medicare and Medicaid have paid for the same services. (OAS; W-00-13-31305; various reviews; expected issue date: FY 2014; new start)

Screenings of Health Care Workers: OIG will review health-screening records of Medicaid home health care workers to determine whether the workers were screened in accordance with federal and state requirements. Examples of health screenings can include vaccinations for hepatitis and influenza. (OAS; W-00-11-31387; W-00-12-31387; various reviews; expected issue date: FY 2013; work in progress.

Provider Compliance and Beneficiary Eligibility: OIG will review HHA claims to determine whether providers have met applicable criteria to provide services and whether beneficiaries have met eligibility criteria. Providers must meet criteria, such as minimum number of professional staff, proper licensing and certification, review of service plans of care, and proper authorization and documentation of provided services. (OAS; W-00-10-31304; W-00-11-31304; W-00-12-31304; various reviews; expected issue date: FY 2013; work in progress)

Homebound Requirements: OIG will review CMS policies and practices for reviewing the sections of Medicaid State plans related to eligibility for home health services and describe how CMS intends to enforce compliance with appropriate eligibility requirements for home health services. The office will also identify the number of states that violate federal regulations by inappropriately restricting eligibility for home health services to homebound recipients. (OEI; 00-00-00000; expected issue date: FY 2014; new start)

Read the entire OIG report

October 15, 2012

TX HHA owner pleads guilty to $374 million in fraud

From the Northern District of Texas ….

A Dallas-area home health services company owner admitted his role in a $374 million home health fraud scheme in which he and others conspired to bill Medicare for unnecessary services that were never performed. Cyprian Akamnonu, 64, of Arlington, Texas, entered his guilty plea to one count of conspiracy to commit health care fraud before U.S. District Judge Sam A. Lindsay in Dallas federal court.

According to court documents, beginning in at least January 2006, Akamnonu, along with his wife Pat Akamnonu, owned and operated Ultimate Care Home Health Services, Inc. Cyprian Akamnonu admitted that he directed his wife and others to recruit Medicare beneficiaries from Dallas neighborhoods for home health services they did not need and for which they did not qualify. Once the beneficiaries were recruited, Cyprian Akamnonu would take prescriptions for home health services to the offices of Medistat Group Associates, P.A., owned and operated by co-defendant Jacques Roy, M.D.

See the whole release from the Department of Justice