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NAHC Report: Issue# 2540, 10/31/2014
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
CMS Revises Time Frames for Medical Review Determinations
NAHC President Responds to CMS’ Final Rule on Home Health Payment Rate
For Your Information: National Institute for Health Care Management Foundation’s Improving Access to Integrated Palliative Care Webinar Archive Available
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CMS Revises Time Frames for Medical Review Determinations

The Centers for Medicare & Medicaid Service (CMS) has issued Change Request (CR) 8443, which instructs the Medicare claims review contractors that determinations on prepayment reviews for the Medicare Administrative Contractors (MACs) and post- payment reviews by the Recovery Audit Contractors (RACs) must be completed within 30 calendar days. Currently the contractors have up to 60 days to make a claim review determination.

For prepayment reviews: the MAC must do the following within 30 days of receiving documentation from additional documentation requests (ADRs). 1) make and document the review determination and 2) enter the decision into the Fiscal Intermediary Shared System (FISS), Multi-Carrier System (MCS), or the VIPS Medicare System (VMS). The 30 calendar day timeframe applies to prepayment routine reviews, prepayment complex reviews and prepayment documentation compliance reviews. For Third Party Liability claims, the MAC has 60 days to make a review determination.

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NAHC President Responds to CMS’ Final Rule on Home Health Payment Rate

Val J. Halamandaris, President of the National Association for Home Care & Hospice (NAHC) recently responded to the Centers for Medicare and Medicaid Services (CMS) final rule on the home health payment rate, the face-to-face encounter regulation and more.

“We are delighted that CMS has heard and acted upon our recommendations to eliminate the daunting physician narrative requirement in the face-to-face encounter rule,” said NAHC President Val J. Halamandaris. “NAHC will continue fighting for the industry to get relief for past claims denied since this change only applies starting January 1.”

On June 5, 2014, after extensive meetings with the highest levels of CMS officials, NAHC reluctantly filed a lawsuit to block a proposed regulation that would deny patients access to home health services.

Halamandaris also praised CMS for its modification of requirements on patient assessments regarding therapy services. “We applaud CMS for accepting the recommendations of therapists and home health agencies nationwide to streamline the therapy reassessment standards in a manner that achieves quality of care, efficiencies, and program integrity,” he stated.

To read more on CMS’ Final Rule on Home Health Payment Rates, please click here.

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National Institute for Health Care Management Foundation’s Improving Access to Integrated Palliative Care Webinar Archive Available

The NIHCM Foundation’s recent webinar “Improving Access to Integrated Palliative Care” is now available online.

 The event featured the following presentations:

  • Senator Bill Frist made the case for palliative care, summarizing the evidence on patient and cost outcomes and noting that most successful models are patient- and family-centered and rely on value-based payments.
     
  • Diane Meier illustrated widespread gaps in support for the seriously ill, highlighted payer initiatives to promote palliative care, and emphasized that cost reductions require a focus on quality, guidelines-based care.
     
  • Speakers from Aspire Health  described a scalable model for outpatient palliative care, including its approach to home visits and patient records and its impact on advanced care planning and hospital admissions
  • Speakers from Blue Cross Blue Shield of Illinois described their partnership with local hospitals to improve communication about treatment goals and better coordinate care for patients with advanced illness.

Video and slides from the presentations are available on NIHCM’s website.

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