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  NAHC Report: Issue# 2983, 8/31/2016
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Medicare Home Health Pre-claim Review Project a “Complete Mess”
Vaccine Reimbursement Guidelines for Home Health Agencies
For Your Information: Home is the Center of Health Care at the NAHC 2016 Annual Meeting Conference and Exposition
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Medicare Home Health Pre-claim Review Project a “Complete Mess”

Forecasts of dire consequences stemming from the recently initiated Medicare home health pre-claim review (PCR) project in Illinois are turning out to be highly accurate. Medicare Administrative Contractor (MAC) PGBA along with CMS Central Office have shown that preparation is falling far short of what is needed to handle simple tasks, such as setting up a reliable documentation submission system. Endless reports of the MAC losing documents submitted electronically led to a CMS recommendation that home health agencies (HHAs) resort to antiquated fax submissions. Those fax submissions faired no better.

“It is a complete mess,” explained Bill Dombi. NAHC’s Vice President for Law. “That is the result that we all predicted given the magnitude of the undertaking that increased the MAC’s claim review workload 40-50 times of its normal volume,” he added.

HHAs report the following with respect to document submissions:

  • “it is taking us an hour for each submission”
  • “documents go through, but PGBA says they are illegible when received”
  • “can not start a PCR, save and finish later”

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Vaccine Reimbursement Guidelines for Home Health Agencies

As agencies gear up for the 2016-2017 influenza season, questions often arise regarding the reimbursement rates and coverage policies for providing the flu vaccine to home health patients and the community.

Influenza vaccines are reimbursed under the Medicare Part B vaccine benefit. Home health agencies (HHAs) may not bill for the vaccine and its administration on a home health claim-type of bill (TOB) 32x. HHAs bill for the vaccine and its administration using the home health claim TOB 34x regardless if the vaccine is provided to a home health patient or a patient in the community. HHAs may also Roster bill for providing influenza vaccines. See the Medicare Claims Processing Manual, chapter 18, for Medicare payment policies related to the influenza vaccine.

There are two payment rates agencies must consider when providing vaccines: payment for the vaccine itself and payment to administer the vaccine.

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Home is the Center of Health Care at the NAHC 2016 Annual Meeting Conference and Exposition
October 23–25, 2016 in Orlando, Florida

Register and Book Your Hotel Room

View the Educational Content

Get started with MyPlanner

View the Schedule at a Glance

Download the Business Case Letter

Exhibitor Service Center

The National Association for Home Care & Hospice invites you to join us and more than 2,500 home care and hospice colleagues in sunny Florida for the 2016 Annual Meeting & Expo. This year’s meeting offers three days of opportunities to learn, connect and discover with unparalleled access to distinguished speakers, hot-topic education sessions and dynamic networking opportunities. Attendees will also have the opportunity to visit our world-class expo where over 200 specialists will showcase the latest in home care and hospice products and services.

Join NAHC and Save: Register by August 14 and save $400 off the full-conference registration. NAHC members pay $800 for the conference; non-members pay $1,200. Click on the link to the right to register.

The Annual Meeting & Expo boasts 80 education sessions across 10 tracks providing the latest research, developments and news in the home care and hospice industry. NAHC 2016 Annual Meeting & Expo provides comprehensive, carefully planned content along with inspirational keynotes and panel discussions. Click on the link to the right to learn more about education sessions.

You’ll have the opportunity to connect with industry leaders from around the country – in the classroom and at the Expo. Plus there are opportunities to network at receptions and meals and in one-on-one discussions throughout the conference.

You’ll discover what’s new this year at the Expo, which features over 200 exhibitors demonstrating and showcasing innovative home care and hospice products and services to support high-quality care. To learn more about exhibiting at the 2016 Annual Meeting & Expo, click here.

Host Hotel
The beautiful Gaylord Palms in Orlando, Florida, is hosting the2016 Annual Meeting & Expo. Book your room early to ensure that you’re just steps away from this year’s conference. (You must first register for the conference to get access to our special room rates at the Gaylord Palms.)

New this Year
My Planner: Take advantage of our online planner and create your own itinerary. Search by keywords or tracks to find the sessions you want to take. And when you’re onsite, you’ll have your personalized plan right on your phone with our conference app.

Learn more about the companies in our Expo before you arrive. Search, research, and interact through our online planner and mark your favorites so when you’re at the Expo you’ll have a personalized floor plan to guide you to the exhibitors you want to see most.

Florida in October is breathtaking. Come early and take advantage of one of our excursions. Whether it’s a theme park or golf, the Kennedy Space Center or a wildlife adventure, check out the options for fun during the registration process.

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