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NAHC Report: Issue# 2480, 8/1/2014
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CMS Fraud Prevention System Identified or Prevented $210 Million in Improper Medicare Payments in Second Year of Operations
ICD-10 Deadline Set for October 1, 2015
For Your Information: FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations
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CMS Fraud Prevention System Identified or Prevented $210 Million in Improper Medicare Payments in Second Year of Operations

CMS reports that its Fraud Prevention System, which employs advanced predictive analytics, identified or prevented more than $210 million in improper Medicare fee-for-service payments, double the previous year. It also resulted in CMS taking action against 938 providers and suppliers, according to a report sent to Congress.

“CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” said CMS Administrator Marilyn Tavenner. “While CMS is continuing to enhance the Fraud Prevention System we have demonstrated that investing in cutting-edge technology pays off for taxpayers and Medicare beneficiaries.”

The Fraud Prevention System is a key element of CMS’ anti-fraud strategy that led to a record $19.2 billion in fraud recoveries over the previous five years. The system uses predictive algorithms and other sophisticated analytics to analyze billing patterns against every Medicare fee-for-service claim, systematically applying advanced analytics on a nationwide scale. The system also uses other data sources including compromised Medicare identification numbers and complaints made through 1-800-MEDICARE.

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ICD-10 Deadline Set for October 1, 2015

CMS has announced the new deadline for ICD-10 implementation as October 1, 2015. Although NAHC was anticipating this new deadline, CMS’ announcement makes the new date anticipated.

Per CMS:

“Deadline for ICD-10 allows health care industry ample time to prepare for change.

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases.

This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.”

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FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations
Teleconference held on August 13 at 1.00pm EST. First 300 registrants can participate

The National Association for Home Care & Hospice and the Hospice Association of America invite you to a FREE Hospice Teleconference on CMS’ Final Hospice Payment Regulations titled "What Do the CMS’ Final Hospice Payment Regulations for FY 2015 and Revised Hospice/Part D Guidance Mean to You?"

On May 2, CMS issued proposed regulations to govern hospice payment for Fiscal Year (FY) 2015; these proposed regulations included numerous policy changes that would affect hospice organizations. It is anticipated that CMS will issue final rules at any time and this teleconference provides an opportunity for hospice stakeholders to learn CMS’ final decisions on these pending policy changes. Additionally, on July 18, in response to significant pressure from hospice organizations, beneficiary advocates, and Medicare Part D plans, CMS issued revised guidance related to its prior authorization policy for processing of drug coverage under Part D for hospice patients. This teleconference will cover key issues related to CMS’ revised guidance. Faculty will include: Val J. Halamandaris, NAHC President; Theresa M. Forster, NAHC Vice President for Hospice Policy & Programs and Katie Wehri, Hospice Operations.

Date: Wednesday, August 13, 2014 at 1:00 p.m. Eastern

To Register: Please send an email to Cheryl Lee ( ). The first 300 to email will participate, members will be given priority. The call-in number is 1-888-637-7740; the conference code will be emailed prior to the call.

Questions: We encourage advance submission of questions from participants or submission while the teleconference is live on the date of the broadcast. Should your question(s) not be addressed in the call due to time constraints, we will highlight in NAHC Report. Send questions to Barbara Woolley, at

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