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NAHC Report: Issue# 2165, 4/2/2013
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Recent Audit Finds Two-Thirds of Illinois Medicaid Beneficiaries Ineligible
Early Hospice Payment Reform Analysis Presented by CMS, Abt Associates
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Recent Audit Finds Two-Thirds of Illinois Medicaid Beneficiaries Ineligible

In January 2013, the Illinois legislature began an audit of its Medicaid program in an effort to achieve an estimated $1.6 billion in savings. From the initial sample size – numbering 20,500 beneficiaries – legislators discovered that 13,709, or approximately two thirds, were ineligible. Some didn’t meet income eligibility requirements, while others simply did not live in Illinois.

This finding comes as Illinois debates expanding Medicaid under the Affordable Care Act – and follows the state’s signing of a Memorandum of Understanding (MOU) with Centers for Medicare and Medicaid Services (CMS) establishing the Medicare-Medicaid Alignment Initiative (MMAI) in Illinois on February 22.

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Home health agencies are requested to visit the NAHC website and complete a single question survey located at the bottom right hand corner of the home page.

The survey asks “How many of the physicians that ordered home health services for your patients during March were not enrolled in PECOS?”

Please participate today!

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Early Hospice Payment Reform Analysis Presented by CMS, Abt Associates

Hospice stakeholders attending the National Association for Home Care & Hospice’s (NAHC) March on Washington heard the initial findings of an analysis performed by Abt Associates for the Centers for Medicare & Medicaid Services (CMS). Abt is CMS’ contractor for development of a new hospice payment model.

While work on the payment model is not complete and payment changes have not yet been decided on, the findings indicate that CMS and Abt are looking broadly at hospice cost report, claims, and beneficiary data to gain a better idea of hospice care delivery patterns. Additionally, Abt is analyzing care patterns related to the hospice face-to-face to determine whether the new requirement is having an impact on hospice use.

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Director of Compliance
Community Health Systems Professional Services Corporation
Community Health Systems Professional Services Corporation seeks a Director of Compliance for its Franklin, TN, headquarters’ Corporate Compliance (Home Care Division) team. The Director of Compliance is a liaison to an assigned group of home health and hospice agencies.
Essential Duties and Responsibilities: Ensure full implementation of the CHS Corporate Compliance Program at each agency assigned to the Director. Develop training and education programs for regulatory changes and topics identified as potential risk areas. Structure tools for use with compiling data and trend analysis. Assess auditing and monitoring trends and coordinate mitigation activities when opportunities for improvement (audit variances) are identified. Prepare oral and written reports, including recommendations for improvement based on audit and investigative findings. Monitor Compliance Committee minutes to ensure adequate follow-up of potential risk areas. Maintain an awareness of current laws, statutes, regulations, etc. that impact healthcare operations and physician relationships. Conduct focused compliance audits on topics of concern. Coordinate compliance policy development and/or revision, when necessary. Participate in compliance and privacy investigations. Other duties as assigned by the VP, Corporate Compliance and Privacy Officer. This position will require travel up to 40% of the time.
Education/Experience: The Director must have current experience working within the Home Health and Hospice industry and should be familiar with reimbursement methodologies and regulations pertaining to benefit coverage. Bachelor’s degree in Health Information Management, Nursing, Business, or related area, or three or more years’ experience in compliance functions. The Director must have the ability to plan, develop, and present educational or programmatic materials in front of an audience greater than 20 people.
To apply for this job, please visit the career section of and apply to Job Number 1254993.

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