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  NAHC Report: Issue# 2620, 3/11/2015
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CMS Releases Change Request Outlining Penalties for Hospice Agencies that Do Not Submit Required Quality Data
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CMS Releases Change Request Outlining Penalties for Hospice Agencies that Do Not Submit Required Quality Data

The Centers for Medicare & Medicaid Services (CMS) on March 6, 2015, released change request (CR) 9091, which addresses payment to hospice agencies that do not submit required quality data and outlines the penalties for failure to report.

For fiscal year 2014, and each subsequent year, if a hospice agency does not submit required quality data, their payment rates for the year will be reduced by 2% for that fiscal year. Application of the 2% reduction may result in an update that is less than 0.0 for a fiscal year and in payment rates for a fiscal year being less than such payment rates for the preceding fiscal year. In addition, reporting-based reductions to the market basket increase factor will not be cumulative; they will only apply for the fiscal year involved.

For calendar year 2014, CMS considers Hospice Item Set data submitted by the hospices to CMS for reporting periods beginning on or after July 1, 2014, through December 31, 2014, as meeting the reporting requirements. For calendar year 2015 and subsequent years, CMS considers Hospice Item Set data submitted by the hospices to CMS for reporting periods beginning on or after January 1 through December 31 as meeting the reporting requirements for that year. Hospices that receive notification of Medicare certification on or after November 1 of the preceding year involved are excluded from any payment penalty for quality reporting purposes for the following fiscal year.

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CMS Updates Program Integrity Manual

The Centers for Medicare & Medicaid Services (CMS) has issued change request (CR) 9065 that incorporates provisions in the final rule (CMS-6045-F) entitled “Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment” into chapter 15 of the Medicare Program Integrity Manual. The CR also addresses several minor provider enrollment policy issues that have arisen recently.  

The CR incorporates several provisions that strengthen enrollment policies related to denials and revocations. For example, reasons for denials related to existing overpayments now include providers and suppliers or owners that were previously the owner of a provider or supplier that had a Medicare debt. In addition, CMS includes several factors to be considered in determining if uncollected debt poses an undue risk of fraud, waste, or abuse.

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Capitalizing on the Private Duty Revolution

Demography will determine the destiny of private duty home care in the next three decades. As the 78 million baby boomers reach their retirement years, most of them will want to age at home — and there will be a booming market for both the medical and nonmedical support private pay home care provides. How can private pay agencies meet the enormous demand in store? And how can they work together to ensure the future of their field? Get the answers from our experts as they show how the graying of our country can be a golden opportunity for you. A revolution in home care is brewing that could mean more revenues for private pay.

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