ARTICLES

Review Choice Demonstration is HERE!

The choice selection period for HHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019.  HHAs should visit the Palmetto GBA provider portal here for information and instructions on the selection process.  Beginning April 17, 2019, HHAs will be able to view their available choices and make their selection through the portal.  Palmetto GBA will also send letters to all Illinois HHAs detailing this information; however, HHAs do not need to wait to receive their letter and may go to the provider portal starting on April 17, 2019.  HHAs that do not make a choice selection by May 16, 2019 will be automatically placed in Choice 2: Postpayment Review. Following the close of the choice selection period, the demonstration will begin in Illinois on June 1, 2019, and all episodes of care starting on or after this date will be subject to the requirements of the choice selected.

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Trump Administration Calls for Medicaid Overhaul, $846 Billion in Medicaid Cuts

March 11, 2019 | Robert Holly

The Trump administration on Monday released its proposed budget for fiscal year 2020, calling for government-wide domestic spending cuts of 5%, a site-neutral payment system for health care providers and a major Medicaid overhaul.

The proposed budget — unlikely to make it past a democrat-controlled House of Representatives — also seeks to curb Medicare spending by increasing prior authorization on items vulnerable to fraud, waste and abuse.

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CMS Lifts Moratoria on Home Health after 5 Years

February 4, 2019 | Baily Bryant

The long-standing moratoria on new Medicare home health agencies is no longer in effect anywhere in the U.S. The Centers for Medicare & Medicaid Services (CMS) allowed the temporary ban to expire on Jan. 30, a move that will likely improve patient access to home-based care in related markets, experts say.

CMS initially implemented a six-month moratoria back in 2013 in Illinois’ Cook County and Florida’s Miami-Dade County. It temporarily froze Medicare provider enrollment as a way to combat widespread fraud, waste and abuse. Over the years, CMS repeatedly renewed and extended the moratoria to Florida, Illinois, Michigan and Texas.

CMS credits new tools that address integrity concerns within home health agencies — such as Review Choice Demonstration (RCD) — as catalysts of the change.

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Home Health Providers Lag Behind Skilled Nursing Facilities in Preventing Re-Hospitalizations

March 12, 2019 | Baily Bryant

While home health care is often touted as a cost-effective way to reduce readmissions, skilled nursing facilities (SNFs) — though more expensive — might be better at keeping patients out of the hospital post-discharge.

That’s according to a new article published in JAMA Internal Medicine, which shows readmission rates for patients discharged to home health agencies were 5.6 percentage points higher than those who went to SNFs.

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Payment Changes for Future of Home Health: Bundled versus Patient Stay

March 13, 2019 | Lisa Remington

In this FutureFocus, the future payments for post-acute providers is being discussed. Will the future of post-acute payments be based on episode of care (bundled payments) or individual patient stay? Weighing-in is MedPAC, the committee that reports to Congress on Medicare. This is a must read to understand the future of PAC payments and the IMPACT Act.

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How to Handle a Home Health Audit, according to a CMS Auditor

March 13, 2019 | Baily Bryant

If you operate a home health agency, Laura Long and her colleagues are probably the last people you want to hear from.

Long is the Medicare operations lead at AdvanceMed, one of five unified program integrity contractors (UPICs) nationwide hired by the Centers for Medicare & Medicaid Services (CMS) to audit and investigation home health agencies.

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PDGM Analysis by Type of Agency

March 21, 2019 | Lisa Remington

CMS analyzed the PDGM’s likely impact in the 2019 home health payment rule, finding that, in general, funds would be redistributed from HHAs that provide more therapy to those that provide relatively more nursing.

Specifically:

  • Payments in 2020 would increase by 2.9 percent for non-profit agencies and 3.9 percent for facility- based HHAs.
  • Payments would fall by 1.2 percent for freestanding agencies and fall by 2.2 percent for for-profit HHAs.
  • HHAs in urban areas would see a 0.6 percent payment decrease, while those in rural areas would see a 4.0 percent increase.
  • Payments would rise for smaller providers and fall for larger providers. For example, payments would increase by 1.9 percent for the 2,841 HHAs with less than 100 episodes in annual volume and would drop 0.2 percent for larger HHAs with more than a 1,000 episodes a year.

 

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