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:: NAHC Report
 
  NAHC Report: Issue# 2789, 11/13/2015
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
CMS to Activate Advance Care Planning Codes
Hospice Obtains Restraining Order Against CMS For Medicare Administrative Appeal Backlog
For Your Information: 2016 Private Duty Home Care Conference
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CMS to Activate Advance Care Planning Codes
Practitioner payment for CPT codes 99497 and 99498 effective January 1, 2016

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) placed on public display the final rule governing Medicare Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016, which includes information on payment for advance care planning (ACP). The Rule is scheduled to be published in the Federal Register on November 16. Previous NAHC Report coverage on the rule is available here.

As part of the final rule, CMS announced its plans to move forward with activation of:

  • CPT code 99497 [Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed) by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate] ; and
  • An add-on CPT code 99498, [Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; each additional 30 minutes (List separately in addition to code for primary procedure)].

These activities may be billed on the same day or on a different day from billing of other Evaluation and Management (E&M) services, but may not be billed on the same date of service as certain critical care services including neonatal and pediatric critical care.

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Hospice Obtains Restraining Order Against CMS For Medicare Administrative Appeal Backlog

A hospice provider in Savannah, Georgia, recently took the government to federal court, challenging the interminable backlog in the Medicare administrative appeals process. Faced with millions of dollars in proposed recoupments that would have forced it out of business, the hospice provider sued the Centers for Medicare and Medicaid Services (CMS) in federal court and obtained a temporary restraining order prohibiting the government from recouping alleged overpayments while the provider pursued its administrative appeal rights. Following an evidentiary hearing on additional injunctive relief, CMS agreed to settle the case and stay recoupment until after the provider’s administrative appeal rights are exhausted.

Like many providers, Hospice Savannah found itself subjected to a Zone Program Integrity Contractor (ZPIC) audit. Despite Hospice Savannah’s stellar, objective performance metrics, the ZPIC sought to impose adjustments on a handful of claims and then use statistics to extrapolate those adjustments across the provider’s universe of claims. Filing administrative appeals, Hospice Savannah challenged the attempted adjustments, as well as the statistical extrapolation, which was based on an untested methodology that has not been peer reviewed by statistical experts.

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2016 Private Duty Home Care Conference

At the Private Duty Home Care Conference, you’ll participate in education sessions on marketing and operations tactics, financial acuity, staff recruitment and retention, and more. You’ll hear from leaders and experts at lectures, roundtables, panel discussions, and more. You’ll learn from success stories and pioneering strategies with statistical analysis, data-driven forecasting, improvement studies, and more. Our conference faculty will guide you through legal and regulatory changes. We value what Private Duty brings to the industry and we support your business achievements.

The Private Duty Home Care Conference will feature one-and-half days of speakers, education sessions, and networking opportunities in charming Charleston, South Carolina where you’ll enjoy special rates at the Doubletree Hotel in the heart of the Market District. Reserve your room now to take advantage of our special low rate of $159 while rooms are still available.

This conference is where you can get real solutions to real issues. So, together we can make real progress.

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