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CMS and Other Regulatory News
Pre-Claim Review Shut Down - For Now(4/5/2017)
CMS's last-minute suspension of the Pre-Claim Review demonstration in Illinois and simultaneous postponement of its start in Florida was not as spontaneous as it first appeared. We got the full story from people who watched it unfold, people from Illinois and Florida. There are implications for providers in all states.
Medicaid Cuts Would Force People with Disabilities into Nursing Homes(3/22/2017)
We dropped in on a press conference conducted by a Colorado non-profit that provides services, including home care services, to people with disabilities. The company's CEO had done quite a bit of research on the impact the American Health Care Act would have on the disabled should it become law.
Meet CMS Administrator Seema Verma(3/15/2017)
What can the Healthcare at Home industry expect from the new CMS boss?
They're Back! Recovery Audit Contracts Awarded(3/8/2017)
Five RAC regions. Three new RAC contractors. Only one will address home health, home medical equipment, and hospice, not in its region but nationwide. Get acquainted with "Performant."
Palliative Care Providers Finding No Pain Relief(3/1/2017)
Can it really be this difficult to comply with MACRA? Palliative care providers are now facing penalties as high as 9 percent. We may have found a workaround for some of them.
New CoPs Demand Software Changes (2/22/2017)
The new Home Health Conditions of Participation take effect on July 13. We asked some software developers what they have to do to help their clients comply.
CMS Ordered to Create Its Own Corrective Action Plan(2/1/2017)
Bureaucrats at CMS are getting a chance to find out what it is like to be forced to follow a Plan of Correction. Ordered by the court to improve its messaging, agency failed to write a required paragraph, so the judge wrote it for them.
Failing Pre-Claim Review Experiment Should Not Expand to Another State(1/25/2017)
Guest author Julianne Haydel brings a 20-year veteran home health consultant's perspective to the crisis PGBA has created in Illinois with the way it is implementing the CMS Pre-Claim Review experiment in Illinois.
Oblivious CMS Did Not Consider All Consequences of Certified Software Rule(1/25/2017)
Last week, we spoke of a light at the end of the tunnel for hospice-based palliative care providers. It turns out it was the headlight of an oncoming train.
Loophole May Provide Hope for Beleaguered Palliative Care Providers(1/18/2017)
The MACRA law is being implemented by CMS in a way that creates a dilemma for palliative care providers based inside hospices. We spoke with the Center to Advance Palliative Care and learned there may be hope.
Comments to CMS by the Center to Advance Palliative Care(1/11/2017)
CAPC sent comments to CMS on November 15, 2015 and June 27, 2016. We have been given permission to reprint the sections commenting on the new requirement to submit via "certified" EMR software.
CMS Creates Catch-22 For Palliative Care Providers(1/4/2017)
CMS set to punish good providers again. Is a healthcare provider obligated to comply with a regulation if the regulator has made compliance impossible?
PCR Improving as PGBA Behavior Grows Increasingly Inexplicable(12/14/2016)
Illinois providers doubt CMS knows what PGBA pre-claim reviewers are doing.
Home Health Will Continue to Be An OIG Target (12/14/2016)
The OIG has made it clear that the effort to eradicate Medicare fraud, waste and abuse will continue as the Presidential transition proceeds. With this announcement they have issued a disturbing warning.
A Peek Into ZPIC Working Conditions May Explain High Error Rate(12/7/2016)
As the ZPIC system gives way to a new Unified Program Integrity system, we thought it would be helpful to get some insight into the people who have been investigating the care given by Medicare providers, looking for fraud and abuse. What better source than the people themselves?
Who is CMS Administrator-Designate Seema Verma?(11/30/2016)
President-elect Donald Trump has named his choice for CMS Administrator. Who is Seema Verma and what kind of administrator will she be?
CMS Continues to Assert Pre-Claim is Going Well(11/9/2016)
Reports from Illinois providers continue to fuel doubt that CMS will ever be able to expand its Pre-Claim Review pilot to all 50 states.
New RACs and New Rules(10/26/2016)
Brace yourselves. RACs are back. This time there are more of them but, attorney Elizabeth Hogue explains, they will still pit their subjective definition of homebound status and terminal illness against yours. There is some good news in the new rules, however. Read on...
CMS Document Spins Early Illinois Pre-Claim Results Beyond Recognition(10/12/2016)
CMS internal document offers a description of the Illinois pre-claim experience that is unrecognizable to Illinois providers. NAHC counters nearly every CMS statement.
You'll Love What a Judge Recently Said About Medicare (10/12/2016)
"What happens if we reach the point where even these legislating agencies don't know what their own 'law' is?" asks U.S. Court of Appeals for the Tenth Circuit, calling the complex regulatory environment CMS has created "The Strange World of Medicare."
NAHC Response to CMS Pre-Claim Report(10/12/2016)
Less than 24 hours after CMS released its report on early successes of the Pre-Claim Review experiment in Illinois, the National Association for Home Care called foul. Here is VP for Law Bill Dombi's verbatim response.
Pre-Claim Continues to Grow Worse in Illinois(10/5/2016)
A quick glance at page after page of comments and complaints on the Illinois Association for Home Care listserv makes it crystal clear that CMS needs to stop this chaotic pilot today.
CMS Postpones Pre-Claim(9/21/2016)
To many, CMS's decision to postpone implementation of the Pre-Claim Review experiment in Texas, Florida, Michigan, and Massachusetts does not come as a surprise. Poorly trained reviewers make so many mistakes, it may be wise to turn the program off in Illinois as well, where it has already begun but is not working.
Illinois Home Health Providers Frustrated, Angry, But Not Powerless(9/21/2016)
Almost everything that can go wrong has gone wrong in the first state burdened with poorly planned Pre-Claim Review experiment.
Home Health Providers Bear Some Responsibility Too(9/21/2016)
In marriage and in Medicare, there are always two valid sides to every argument. Just because most of the blame for the Illinois fiasco can be attributed to PGBA does not mean that HHAs are blameless. Those who intend to be in business next year must set the bar higher for employees who create, review, and submit clinical documentation.

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