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NAHC Report: Issue# 2312, 11/8/2013
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CMS Announced PECOS Activation for January 6, 2014
CDC Calls Attention to Bacteria Resistance
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CMS Announced PECOS Activation for January 6, 2014

The Centers for Medicare & Medicaid Services (CMS) announced the full implementation of the Provider Enrollment, Chain and Ownership System (PECOS) edits on ordering/referring providers in Medicare Part B, DME, and Part A home health agency (HHA) claims. CMS will turn on the Phase 2 denial edits beginning January 6, 2014. This means that Medicare will deny claims for services or supplies that require an ordering/referring provider to be identified - and that provider is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed.

This will be the second attempt by CMS to implement the PECOS edits. CMS issued a Special Edition MLN Matters® Article on March 1, 2013, that announced the full implementation of the PECOS edits effective May 1, 2013, however, due to technical issues delayed the implementation.

This announcement reiterates the rational for the requirement and CMS’ implementation policy for ensuring that only physicians who are eligible to order and refer home health services are reported on claims with a their associated national provider identifier (NPI). The following is an excerpt from the MLN Matters®:

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Join DecisionHealth and the Private Duty Homecare Association for the Private Duty National Conference & Exposition
November 18 – 20 in Las Vegas, NV.

Secure your place at the Private Duty Homecare Association’ Private Duty National Conference & Exposition.

Visit DecisionHealth’s website for more details and registration information.

Join hundreds of private duty executives at the 16th Annual Private Duty National Conference & Exposition to learn strategies and best practices to grow and thrive in the rapidly-changing, non-medical home care market. The conference will provide attendees with the skills needed to:

  • Manage the impact of the companionship exemption
  • Prepare for state-licensing requirements
  • Grow referrals with innovative sales and marketing effort
  • Mitigate the revenue impact of employer insurance mandate
  • Boost your bottom line by becoming a care-transition partner
  • Measure your agency against national norms
  • Ensure compliance with labor laws

For complete details, click here to view the full agenda.

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CDC Calls Attention to Bacteria Resistance

Shortly before the partial government shutdown, the Centers for Disease Control and Prevention (CDC) issued a wakeup call – in the form of a report – on the increasingly alarming growth of antibiotic resistance in the United States, with implications for healthcare providers. Threats to public health were grouped according to risk levels: Urgent, Serious, and Concerning. The Urgent or greatest risk category includes a bacterium that has gotten much attention in recent years, Clostridium difficile (C. difficile). CDC emphasizes that C. diff, as it is known, can cause life-threatening diarrhea. The report notes infections “mostly occur in people who have had both recent medical care and antibiotics. Often, C. difficile infections occur in hospitalized or recently hospitalized patients” or nursing home patients, those with a weakened immune system who were exposed to multiple antibiotics or long-term use.

In 2000, a stronger strain of the bacteria emerged, CDC adds. “This strain is resistant to fluoroquinolone antibiotics, which are commonly used to treat other infections.” Deaths related to C. difficile increased 400 percent between 2000 and 2007.

The pathogen is responsible for 250,000 infections per year requiring hospitalization or affecting already hospitalized patients. “In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented.” More than 90 percent of deaths occur in people 65 and older.

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