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:: NAHC Report
  NAHC Report: Issue# 2923, 6/9/2016
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UPDATED: CMS Issues Plans for Pre-Claims Review for Home Health Agencies
Providers Encouraged to Complete the MAC Satisfaction Survey
For Your Information: How to Avoid Risk while Meeting Care Needs: Getting Hospice GIP and Continuous Care Right!
Job Corner: 1) Executive Director, VNAs of Vermont; 2) Director, Hospice, OSF Healthcare
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UPDATED: CMS Issues Plans for Pre-Claims Review for Home Health Agencies

The Centers for Medicare & Medicaid Services (CMS) has posted in the Federal Register  a Notice announcing a 3-year Medicare pre-claim review demonstration for home health services in the states of Illinois, Florida, Texas, Michigan, and Massachusetts where there have been high incidences of fraud and improper payments for these services.

The proposed demonstration will begin in Illinois not earlier than August 1, 2016, will begin in Florida not earlier than October 1, 2016, and will begin in Texas not earlier than December 1, 2016. The demonstration will begin in Michigan and Massachusetts not earlier than January 1, 2017. Providers in each state will be notified by the appropriate Medicare Administrative Contractor (MAC) prior to the start of the demonstration in the state.

The details of the demonstration are still not clear. However, CMS seems to be moving away from the concept of a “preauthorization” demonstration, that was originally proposed, to a “pre- claim review” demonstration where the agency will submit a pre-claim review request to receive a determination regarding eligibility  and coverage before submitting a claim. The main driver for the demonstration remains efforts to reduce improper payment related to insufficient documentation.

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Providers Encouraged to Complete the MAC Satisfaction Survey

The annual MAC Satisfaction Indicator (MSI) is now available on each of the contractor’s web site. The survey is an opportunity for home health and hospice agencies to provide feedback on their respective Medicare Administrative Contractor (MAC).

The MSI takes about 10-15 minutes to complete and is designed to measure your satisfaction as a Medicare provider with the performance of your MAC. The MSI will not measure your satisfaction with other Medicare contractor types such as the Railroad Retirement Board (RRB), Recovery Audit Contractors (RACs), and Comprehensive Error Rate Testing (CERT) contractors, Zone Program Integrity Contractors (ZPICs), Supplemental Medical Review Contractors (SMRCs) or Qualified Independent Contractors (QICs). 

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How to Avoid Risk while Meeting Care Needs: Getting Hospice GIP and Continuous Care Right!
Web Event: Tuesday, June 21, 2016, 1:00 PM – 2:30 PM Eastern

Program Description:

As part of the Medicare participation agreement, hospices commit to having general inpatient acute care (GIP) and continuous home care (CHC) available when patient need dictates that one of these levels of care is appropriate. Research findings of the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG) have raised serious concerns about potential misuse of GIP — including both inappropriate use when patients are not eligible as well as instances where hospices do not have GIP available in the event that a patient may need it. These concerns have only intensified with the findings from data gathered for use in hospice payment reform efforts. CMS is also closely watching utilization trends in continuous home care (CHC). Given that CHC and GIP are under intense scrutiny, it’s time to ensure that your use of these levels of care “syncs” with the applicable regulations. As a special bonus, attendees will receive a GIP Audit Tool for use in their agency.

Program Objectives:

  • Review the CMS regulations for the GIP and CHC levels of care
  • Discuss the similarities and differences between general inpatient care and continuous care
  • Identify patient eligibility criteria and expected documentation for each level of care
  • Discuss barriers to the use of GIP and CHC
  • Share applicable scenarios for utilizing each level of care

Panel of NAHC Experts:

  • Katie Wehri, CHC, CHPC, Hospice Operations Expert, NAHC
  • Susan Garcia Strauss, Chief Compliance Officer, HopeHealth, Hyannis, MA


Live Event plus Recording: Members -$150, Non-members - $300

Recording Only: Members -$150, Non-members - $300

Click Here to Register!

Executive Director, VNAs of Vermont

The VNAs of Vermont is a membership organization of ten not-for-profit Visiting Nurse Associations in Vermont. The purpose of this organization is to increase knowledge of and to develop, improve, and expand the quality of community based home health and hospice care in Vermont. This is done through fostering collaboration and cooperation amongst member agencies and partner organizations and programs, education, leadership and public policy and advocacy.

The Executive Director is a dynamic leader who creates vision and strategically executes a plan to the membership organizations:

  • Works in conjunction with the Board of Directors to prioritize initiatives, issues, and presents to legislators or state officials
  • Possess knowledge of health care reform, accountable care organizations and health care provider systems in conjunction with home health and hospice’s role in the delivery of health services
  • Demonstrates skills as an effective and persuasive communicator, negotiator and motivator
  • Demonstrates creative thinking and innovative capabilities for and with the members.

To apply, forward cover letter, resume, and salary expectations to Sandy Rousse, VNAVT President:, or by mail: CVHHH/VNAs of VT ED Search, Attn: Sandy Rousse, CEO, 600 Granger Road, Barre, VT 05641.

Director, Hospice

OSF Healthcare “More than a Career … A Calling”

OSF Healthcare has a Director, Hospice opportunity available in our hospice division, located in Peoria, IL. The responsibilities would include supervision and operational oversight of hospice operations in all regions and for the clinical care and non-clinical services delivered to patients with twenty-four hour accountability for patient care and operations of the hospice division. Candidates must have a current RN license and bachelor’s degree. Three years of management/supervisory experience and hospice experience preferred. OSF Healthcare offers excellent benefits and compensation.

Inquires can be directed to or please apply online at

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