Volume 12, Number 39 February  22, 2023



BREAKING NEWS

Last issue, we ran several articles critical of private, for-profit insurance companies running Medicare Advantage plans (see "Most-Read Articles" below). We learned this week that the reality may be worse than even the most severe accusations we heard and reported on at last month's Home Care 100 gathering. 

According to Kaiser Family News, CMS issued a final rule declaring it would treat MA plans differently than it treats Home Health Medicare episodes and claims from other care providers. When CMS investigates an MA plan's patient acuity assessments, which is how plans are paid, if it finds exaggerations in its samples, it will demand returns of overpayments only from the samples and will not extrapolate to a plan's entire population. 

We ran the Kaiser article by several attorneys and other experts and learned that there is more than one issue at play. CMS is 10 to 12 years behind in sampling MA acuity assessments, though it does not explain why. CMS is never more than three years behind examining Home Health and Hospice claims. When its contractors do find overpayments in our industry, they always extrapolate from samples, often resulting in crippling repayment demands. 

 

 

Is Fairness Off the Table?

Or do insurance companies simply have that much clout?

The largest in-home care providers report annual revenues in the $2 to $2.5 billion range. There are not many in that category, mostly national providers that have grown by acquisition. It has always been the case that more than two-thirds of Home Health providers gross $2 million per year or less.

In contrast, CMS reported that Medicare will pay $385 billion in 2023 to insurance companies such as United Health, Humana, Anthem, Aetna, and Cigna. You know them, the ones that advertise during every TV commercial break throughout the annual enrollment period, usually fronted by the likes of Joe Namath and Jimmy Walker and other aging celebrities.

It gets worse.

We reported nearly five years ago that MA plans pad their Medicare revenue by exaggerating patient acuity, resulting in a net cost to the Medicare trust fund 1.2 percent higher than per-patient costs for traditional Medicare. In addition, they deny care at a higher rate than traditional Medicare and apparently not for legitimate reasons. When appealed, 75 percent of MA denials are overturned, most in the first level of appeal without having to get to the ALJ level.

 

 

This was not the only time we reported on this scandal. Here is a report Darcey Trescone and I did in 2020. It compares $192 million of suspected Home Health fraud unearthed by the OIG to a $1.4 billion lawsuit by the Justice Department against a cheating MA plan.

First read the article by Kaiser's investigative reporter Fred Schulte, reprinted with the permission of Kaiser Health News, then switch to our commentary and reflections from our expert panel. Let us know whether you are as appalled as we are. Then take action in two ways. CMS needs to hear from you, otherwise it will think you are OK with its unequal treatment of MA plans. And get more aggressive when MA plans deny care. Yes, 75% of appeals are successful, but less than 2% of denials are appealed. It is your money. 

Have a great week. Keep making a difference!

Editor signature
Tim Rowan



Government Lets Health Plans That Ripped Off Medicare Keep the Money
CMS says it will not extrapolate overpayments for MA plans the way it does for Home Health episodes, but only charge for the samples.

Home Health Experts React to Special Treatment of MA Plans
Attorneys and consultants talked to us about a new CMS Final Rule's double standard.



During the 4th Quarter of 2023, web sites of the above advertisers were visited by home care and hospice executives and staff 30286 times.

To inquire about placing your message here, contact:

Kristin@rowanresources.com

As of this date, approximately 48,796,000 Baby Boomers have become Medicare eligible.

 

Last Week's Most-Read Stories:

Medicare Advantage Is Neither Medicare Nor an Advantage
Former insurance executive who used to sell Medicare Advantage explains why it is stealing from taxpayers and seniors.

Our Medicare Payment System is Broken
At Home Care 100, four top executives and one MedPAC commissioner agree. The formulae CMS use to calculate profit margins and determine rate cuts is "stupid."


Upcoming Events

 

Shine Your Light
Illinois HomeCare & Hospice Council Annual Meeting and Exposition

Dates: April 9-10
Venue: NIU Naperville

Information and Registration


FREE WEBINAR: CMS’ Proposed Hospice FY2024 Payment Rule: Implications for Agencies and the Hospice Community

Sponsored by NAHC
Featuring: Theresa Forster, Katie Wehri

Date: April 11
Time: 12:00 - 1:30 EDT

Details and Registration

 

Description: In addition to routine annual payment changes, CMS proposed FY2024 Hospice Payment Rule, issued on March 31, contains valuable updates on the Hospice Quality Reporting Program (HQRP). Perhaps most notable, the rule's deep dive into utilization trends signals an intensified interest in hospice care patterns, potentially inappropriate behavior in the hospice sector, and program integrity concerns.  Join two of NAHC's hospice experts as they detail proposed changes, including a new requirement that hospice certifying physicians be Medicare enrolled (or to have validly opted-out) and CMS' Requests for Information on hospice utilization and health equity, and examine their potential impact on hospice practice going forward.

Faculty: Theresa M. Forster, NAHC VP for Hospice Policy & Programs
Katie Wehri, NAHC Director of Home Health & Hospice Regulatory Affairs


WEBINAR: Audits: What to Do

A 90-minute Lunch & Learn Audio Conference by Elizabeth E. Hogue, Esq. Health Care Attorney

Date: Thursday, April 6
Time: 1:00 - 2:30 EDT

Encore date: April 13
On-demand recording available 24/7
Option to purchase recording and handouts

 

Information and Registration

 

Audio-Conference Description: Home care providers of all types; including home health agencies, private duty agencies, hospices and HME companies; remain targets of audits by various regulators, including but certainly not limited to United Program Integrity Contractors (UPICs). The results of these audits can be devastating because they may threaten the ability of providers to remain in business, especially when overpayments are extrapolated to millions of dollars. Audits of all types must be taken seriously and providers must take action to close audits as quickly as possible! The first thing providers must do is to review records requested by auditors.

The purpose of this teleconference is to give providers detailed steps to follow to avoid adverse consequences of audits. Examples of common issues targeted by auditors will be provided and there will be time for questions and answers.


Rise Above!

Michigan Home Care & Hospice Association Annual Conference

Dates: May 3-5
Venue: Grand Traverse Resort & Spa

Registration and Information

The theme for the Conference is “RISE ABOVE” a fitting recognition of the challenges our industry and each of you overcame in your personal lives and professional careers to navigate the challenges of the past three years.

The MHHA conference presents an opportunity to meet new friends and reacquaint with peers. What better place to rise above, than at the spacious and beautiful Grand Traverse Resort & Spa? This conference has a little bit for every service line and discipline. Wednesday offers a track for Volunteer Managers and Thursday offers a track for Palliative Care as well as many other sessions for Certified Home Health, Hospice, DME and Private Duty Home Care.


Home Care Innovation Forum*Presented by: The Influence Group

Dates: June 4-6
Venue: Park Hyatt Aviara 
City: 
Carlsbad, CA


Information and Registration

Featured Speakers:

Partial list of topics:


HI2: Home Care Innovation and Investment Conference *Presented by: Lincoln Healthcare Leadership

Dates: June 12-14
Venue: Swissotel 
City: 
Chicago


Information and Registration

Featured Speakers:


leading ONE vision

Homecare Homebase User Group Meeting

Dates: June 12-14
Venue: Sheraton Dallas Hotel

Information and Registration

Clinical Education Credits
Nationally recognized speakers, eight clinical sessions. Clinicians are encouraged to sign up for the clinical sessions, but are free to jump between clinical and non-clinical topics. Clinical topics include a homecare focus on Wound Care, Value Based Purchasing, Clinical Leadership, conflict resolution, Quality Report, Oasis and more.

Featured Speakers:


2032 NAHC Financial Management Conference & Exposition

Date: July 16-18
Venue: Hilton Riverside, New Orleans

Information and Registration

 

In addition to NAHC president Bill Dombi, featured speakers will include:


54th Annual Meeting: "Bring Care Home"Presented by: Texas Association for Home Care & Hospice

Dates: August 28-31
Venue: Grand Hyatt Riverwalk
City: San Antonio


Information and Registration


FREE Webinar: "The Role of the Hospice Physician in Organizational Compliance"Presented by: FEMA

Date: September 6

Time: 10:30 AM - 12:00 PM, EDT

Register here 

Collaborating with the Administration for Community Living, the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Policy, Planning, and Innovation, and the Schoharie County, NY, Area Agency on Aging, the webinar is designed to equip organizations with strategies to ensure seamless service continuity during an emergency. 

 


 

Home and Community-Based Palliative Care: Past, Present, and Future
NAHC and HHFMA

September 28, 2023

More Information

 


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2023 NAHC Annual Meeting & Exposition *

"One Voice, Many Stories"

October 15-17
Gaylord Hotel and Conference Center
National Harbor, MD

Information and Registration

Keynote Speakers:

 


 

2023 National Home Care Conference*
Home Care Association of America

October 23-24, 2023

Hilton Chicago
Chicago, IL

More Information

 

 


Vision – Plan – Succeed: 2023 Leadership Conference

Association for Home & Hospice Care of North Carolina

October 29-31, 2023
Renaissance Hotel Ashville, NC

Information and Registration

Featured speakers:

Bill Dombi, Melinda Gaboury, Tim Rogers, Nick Seabrook, Mark Sharp, Robert Markette, Mark Kulik, and more.


Ignite Your Revenue Engine - Virtual

HomeCareSales

November 1-3, 2023

More Information


Strategic Analysis and Provider Guidance

CMS CY2024 Final Rule Cuts to Home Health

Axxess

November 9, 2023
2 PM CST

More Information


Unlocking Home Care Agency Efficiency with AI

Virtual Workshop

Automation Edge

Nov 8, 2023

11 a.m. CST

More Information


Home Health Final Rule: Clinical & Financial Strategies for Success in 2024

McBee Associates

Nov 8, 2023
1:30 - 2:30 p.m. EST
Virtual

More Information


Automating Your Compliance Process in Home Care

AxisCare and CareAcademy

Nov 8. 2023
12 p.m. CT
Virtual

More Information


2023 Annual Conference – Hybrid Hospice & Palliative Care

Hospice & Palliative Care Association of New York State

November 13-14, 2023
Albany Marriott Hotel
Albany, NY

More Information


Call for Speaker Proposals

Association for Home & Hospice Care of North Carolina (AHHC) Annual Convention and Expo

April 7-10, 2024
Raleigh Convention Center

Submit Your Proposal

The deadline to submit a proposal is November 15, 2023.

 


Understanding the CY 2024 Home Health Final Rule:

Your agency's path forward

WellSky

Nov 15, 2023
12 p.m. CST

More Information

Presented by Cindy Campbell, MHA-Healthcare Informatics, BSN, RN, COQS, CHHCM

Request for Speakers: 2024 Annual Conference

Indiana Association for Home Health Care

April 16-17, 2024

More Information

The deadline to submit proposals is November 17, 2023.

Safety Matters: Protecting Home Care Workers from Violence

National Association for Home Care & Hospice

Nov 29, 2023
3:00 - 4:00 p.m. EST

More Information


2023 Virtual Annual Conference
Virginia Association for Homecare and Hospice

Opening Date:November 15

More Information


Rapid Competency and Quality Improvement Training

CMS

November 30, 2023
1:00 p.m. EST

More Information


Safety Matters:
Protecting Home Care Workers from Violence

National Association for Home Care and Hospice

Nov 29, 2023
3 p.m. - 4 p.m. EST

More Information


Turning Lemons into Lemonade: Developing resilience in the face of change

McBee

Dec 6, 2023
1:00 p.m. EST

More Information


CRM Showcase:Empowering Reps for Smarter, More Efficient Growth

Trella Health

December 12, 2023
12 p.m. EST

More Information


Don't be Late for Section GGPrepare now for the new Discharge Function Score

NetSmart

Dec 12, 2023
2:00 p.m. EST

More Information


CRM Showcase: Empowering Reps for Smarter, More Efficient Growth

Trella Health

Dec 12, 2023
12 p.m. EST

More Information


Excavate-Tell-Affirm

Brand Leadership Summit

Revealing Genius

Dec 7-15, 2023
1 p.m. - 2 p.m. EST

More Information


RCM Success Toolkit:

Insights for RCM Leaders

NetSmart

December 14, 2023
2:00 p.m. EST

More Information


Understanding, Identifying, and Overcoming Conscious and Unconscious Bias

Home Care Pulse

Ongoing
FREE Sample Course

More Information


Home Health and Hospice Summit

HealthCare Synergy

January 10, 2024
Renaissance Hotel
Long Beach, CA

More Information


Learn how M1400 Dyspnea Impacts VBP

McBee

January 11
12 noon EST

More Information


2024 Industry Outlook with NAHC President Bill Dombi

NetSmart

Tuesday, January 16
2:30 pm, EST

More Information


Home Care 100*

Lincoln Intelligence Group

January 21-24, 2024
The Fairmont Scottsdale Princess
Scottsdale, AZ

More Information


Provider Enrollment Changes in Medicare

NAHC

January 31, 2024
1:00 P.M. EST

More Information

NAHC would like to thank the sponsor of this webinar, Red Road Healthcare Business Solutions


How to Market Without Violating the Law

Elizabeth E. Hogue, Esq.

February 8, 2024

More Information


Mastering Compliance for a Stronger Healthcare System

NetSmart

February 13, 2024
1:00 P.M. EST

More Information


Clinical Impacts for Success in PDGM

Axxess

February 14, 2024

More Information


Mastering M2020 Oral Medications

McBee a NetSmart Company

February 20, 2024

More Information


Demistifying Value-Based Purchasing:

Current State and for 2025

Axxess

March 7, 2024

More Information


How to get Referrals From ALFs and ILFs

Elizabeth E. Hogue, Esq.

March 7, 2024
Replay Date: March 14, 2024

More Information


Call for Speakers

NAHC Financial Management Conference

Deadline to Submit
March 15, 2024

More Information


Empowering Change: Advocacy in Private Duty Home Care

NAHC

March 27, 2024
2:00 p.m. EDT

More Information


Transforming Community and Home-Based Care in an Aging World

International Home Care Nurses Organization

April 18-20, 2024
York Hotel Singapore
Singapore

More Information


NAHC Advocacy Day

NAHC

April 16, 2024
5:00 p.m. - 8:00 p.m. EDT

April 17, 2024
All day

Capitol Hill, Washington, D.C.

More Information


AGILE: Axxess Growth, Innovation and Leadership Experience*

Axxess

April 21-24, 2024
Irving Convention Center
Dallas, TX

More Information


Annual Conference & Trade Show

Michigan HomeCare & Hospice Association

May 8-9, 2024
Radisson of Kalamazoo

More Information


Home Care Innovation Forum*

Influence Group

May 19-21
Silverado Resort & Spa
Napa, CA

More Information


Home Care 100 Summer*

Lincoln Healthcare Leadership

June 3-6, 2024
Waldorf Astoria Monarch Beach Resort
Dana Point, CA

More Information


2024 KHCA Annual Conference

Kentucky Home Care Association

August 14-15, 2024
Embassy Suites by Hilton Lexington/UK Coldstream
Lexington, KY

More Information


Insight2024

6th Annual Forum on Coding, OASIS & Quality

McBee

Aug 5-7, 2024
Sheraton Overland Park Hotel at the Convention Center
Overland Park, Kansas

More Information


Agency Amplify

HomeCareSales

Recurring
2nd Tuesday

More Information


*The Rowan Report will see you there.


Your state or national association meeting or webinar not listed? Send the details to Conferences@RowanResources.com using this format:

Conference Title
Sponsoring Association
Date(s)
Hotel or Conference Center, City, State
URL



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