CMS Regulatory Updates for Home Health and Hospice
July 10, 2014 09:56 AM
CMS recently issued several regulatory updates to home health and hospice providers. The updates are described below:
CR8690: MACs, SMRCs Must Display Issues Under Review on their Websites
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 8690, under which - effective September 5, 2014 - Medicare’s Administrative Contractors (MACs) must, prior to beginning a service-specific review, post a review description by provider type on their website. MACs must keep the website current by posting active reviews.
CMS indicates that MACs should, at their discretion, state on their website what additional documentation is needed from providers to make a claim determination. CMS also suggested that MACs, at their discretion, create an archive of old review topics that are no longer under active review. CMS also notes that MACs have the discretion to notify providers about a service-specific review by sending individual notices to affected providers and should, at their discretion, state in the written notices what additional documentation is needed from providers to make a claim determination.
Additionally, the CR requires that Supplemental Medical Review Contractors (SMRCs) operate a public Web site that displays what types of issues are under review, and include links to relevant Office of the Inspector General (OIG), Government Accountability Office (GAO) or other reports for each area.
SMRCs are required to notify providers of service-specific reviews by sending additional documentation requests (ADRs) and must also state what additional documentation is needed in response to the ADR to make a claim determination.
NAHC and its affiliated Hospice Association of America (HAA) are supportive of the changes included as part of CR8690 and believe they have been long needed.
CMS Updates Manual Sections to Clarify Process for Form 855
In a recent issuance--Update to Form CMS-855 Application Processing Sections of CMS Pub. 100-8 Chapter 15 (Change Request 8637) -- the Centers for Medicare & Medicaid Services (CMS) has updated and reorganized CMS Pub. 100-8, Chapter 15, to clarify CMS-855 application processing practices. The changes, while significant, make no modification to existing 855 application processing practices.