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:: NAHC Report
NAHC Report: Issue# 2348, 1/8/2014
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Medicare ALJ Hearings to Experience Significant Delays
NAHC is Seeking Member Input on its 2014 Home Care & Hospice Legislative, Regulatory Priorities
For Your Information:Hospice Open Door Forum to be Held January 22, 2014 from 2:00pm – 3:00 PM ET
NAHC/Home Care & Hospice Events
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Medicare ALJ Hearings to Experience Significant Delays

The Office of Medicare Hearings and Appeals (OMHA) revealed this week that it is suspending the assignment of most new requests for an Administrative Law Judge (ALJ) hearing because it has “been unable to keep pace with the exponential growth in requests for hearing.“ While OMHA will continue to assign and process hearing requests filed directly by Medicare beneficiaries, it does not expect to resume assignments of other appeals by providers for at least 24 months with post-assignment hearing wait times continuing to exceed 6 months. That means that home health agencies and hospices that file for an ALJ hearing in January 2014 should anticipate that the hearing will be held no sooner than June 2016.

The OMHA explains that the scheduling problems stem from an “exponential growth in requests for hearing.” Currently there are nearly 357,000 claims that have already been assigned to the 65 ALJs that hear Medicare appeals. In less than two years, pending appeals rose from 92,000 to over 460,000 with weekly appeal receipts growing from 1,250 to over 15,000. These appeals come from all Medicare benefit sectors, including home health and hospice. The massive increase in appeals is concurrent with the expanded volume of claims reviews and expanded number of Medicare contractors reviewing claims. The MACs, ZPICs, and RACs have all contributed to the number of claim denials that result in appeals. For example, home health agencies have experienced a surge in retroactive claim denials related to the physician face-to-face encounter requirements.

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NAHC is Seeking Member Input on its 2014 Home Care & Hospice Legislative, Regulatory Priorities
Member Feedback will Guide NAH’s Legislative and Regulatory Advocacy in the Crucial Upcoming Year

In preparation for the year’s largest gathering of home care and hospice advocates in Washington, DC at the 2014 Home Care and Hospice March on Washington, March 23-26, the National Association for Home Care & Hospice (NAHC) is soliciting members’ and advocates’ input regarding the most important and significant legislative and regulatory challenges and concerns for the home care and hospice industry. NAHC will use these priorities to guide its legislative and regulatory advocacy during the March on Washington and throughout 2014.

Three simple online questionnaires are now available to allow home care and hospice organizations, as well as other interested parties, to provide their input. The questionnaires will only be available through Wednesday, January 22, 2014, so please take a moment and cast your votes as soon as possible. Agencies or organizations that provide only hospice care are asked to complete only the hospice questionnaire.

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Hospice Open Door Forum to be Held January 22, 2014 from 2:00pm – 3:00 PM ET

On Wednesday, January 22, there will be an Open Door Forum focused on the Hospice Quality Reporting Program (HQRP) from 2:00pm – 3:00pm. During this call, both the FY 2015 and FY 2016 Reporting Cycles will be discussed. Additionally, the call will provide information about the upcoming patient/family survey requirements for hospices that will begin January 1, 2015.

The FY 2015 cycle consists of reporting on two measures: the structural measure and the National Quality Forum (NQF) #0209 pain measure. The Hospice Quality Reporting Program Data Entry and Submission Site is now available for data submission. Data for each measure must be submitted to CMS by 11:59pm ET on April 1, 2014 for FY 2015 payment determination. The Technical User’s Guide, posted on the Data Submission web page is the primary reference for the Hospice Quality Reporting Program Data Entry and Submission Site for the FY2015 reporting cycle.

As part of the FY 2016 Cycle, the Hospice Item Set (HIS) will be implemented on July 1, 2014. The HIS is a set of patient-level data items that can be used to calculate 6 NQF- endorsed measures and one modified NQF measure. Training on data collection for the HIS will be offered on February 4 and February 5 in Baltimore. 

Registration for the training is now open. Hospices may also live- stream the event if they are unable to attend in person, or watch the training online at a later date.

After a presentation of information about the FY 2015 and FY 2016 Reporting Cycles, there will be time for a Q&A session.

Additional information about the ODF, including the agenda, call-in information and conference ID, will be posted to the Open Door Forum HHH and DME webpage here.

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