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:: NAHC Report
NAHC Report: Issue# 2446, 6/10/2014
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An Update on Medicare Part D/ Hospice Recovery Request
OMB Begins Review of Medicare Home Health Reimbursement Proposal
For Your Information: Home Health Sessions at NAHC’s Financial Management Conference & Exhibition
NAHC/Home Care & Hospice Events
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An Update on Medicare Part D/ Hospice Recovery Request

The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) wanted to provide an update on the Part D refund requests many hospices have received from PRS.  As was reported at the end of May (see NAHC Report, May 27, 2014), many hospices were receiving refund requests for analgesics paid for by Part D for hospice beneficiaries in 2011 and 2012.  Since that time NAHC and HAA have gained additional information that is of use and interest to hospices.  NAHC and HAA will continue to investigate the requests and will provide updated information as it becomes available. 

Below is what NAHC and HAA have learned thus far:

Optum Rx is a pharmacy benefits manager owned by United Health Group, which also owns United Healthcare.

1.  Medications are not listed on the request letter, only Rx number.  PRS has told NAHC and HAA that they cannot put the medication name in a letter due to privacy requirements. They are, however, working on developing a speadsheet that contains this information.  That spreadsheet would be specific to each hospice and could be e-mailed to the hospice in a secure format.  If the hospice is willing to receive the information this way PRS will send it.

UPDATE:  NAHC and HAA does not have an anticipated completion date for these spreadsheets.  NAHC and HAA have also heard that hospices can call PRS and obtain a list, but we've not been able to confirm this.

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OMB Begins Review of Medicare Home Health Reimbursement Proposal

A recent Bloomberg BNA article announced that the Office of Management and Budget (OMB) has received a proposed rule from CMS that would set 2015 payment rates for home health agencies.

According to the article:

“The rule (CMS-1611-P; RIN: 0938-AS14), would update the 60-day national episode rate based on the applicable home health market basket update and case-mix adjustment, the OMB said.

The proposal also would update the national per-visit rates used to calculate low utilization payment adjustments and outlier payments under the Medicare prospective payment system for home health agencies, it added.

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Home Health Sessions at NAHC’s Financial Management Conference & Exhibition
July 13 – 15 in Chicago, IL

Below are some of the highlights from this year’s Home Health sessions at FMC:

Home Health Cost Containment Strategies
Faced with Medicare rate cuts of 3.5% from rebasing in 2014 with additional cuts scheduled for the next 3 years alongside shifts to a managed care payment model, Home Health agencies need to find new sources of cost savings and operating efficiencies in order to survive… This program offers insights and ideas on successful ways to squeeze out even more efficiencies than you thought possible.

Episode Management: Managing Clinical and Financial Outcomes Before They Occur
The success of care management in home health requires a shift in focus from making visits to managing episodes of care… Episode Management provides the structure for concurrent monitoring of clinical and financial outcomes while there is still influence of control during the episode.

Minimize Denials:  Practicing Effective Home Care Compliance
Agencies must put processes in place to ensure they compliance is monitored.  Learn the common documentation flaws and operational practices, including failure to conduct appropriate pre-billing audits, that could increase your compliance risk

To see all of this year’s Financial Management Conference Educational Sessions, please click here.

To register to attend this year’s Financial Management Conference, please click here.

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