Author Archives: Daniel J. O'Brien

New Hospice Cost Report Released: Effective for Cost-Reporting Periods Beginning Next Week

On August 29, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the final version of the new Medicare cost report, Form CMS 1984-14, applicable to freestanding hospice providers. Freestanding hospice providers must use the new form for cost-reporting periods beginning on or after October 1, 2014. It is anticipated that similar rules for provider-based hospices will follow. A copy of the new form and instructions for completing the same are available here:

The revised cost reporting form is substantially expanded, and requires, among other changes, that providers report direct patient care costs based on the level of care that was provided. In order to comply with these new reporting requirements, hospices will need to modify their existing chart of accounts. One such modification is to ensure that all costs associated with each of the four different levels of care be kept in separate general ledger accounts. This represents a substantial expansion of hospices’ obligations to document costs in their accounting records. However, this practice will facilitate completion of the following new worksheets: (A) A-1: Continuous Home Care; (B) A-2: Routine Home Care; (C) A-3: Inpatient Respite Care; (D) A-4: General Inpatient Care.

The forms and instructions were revised in accordance with the statutory requirement for hospice payment reform, as required under the Patient Protection and Affordable Act, and to incorporate data previously reported on Form CMS-339, the Provider Cost Report Reimbursement Questionnaire. The expanded data captured by the new cost report will be used in future years to facilitate payment reform.

For more information on new hospice cost report, or related Medicare reimbursement issues, please feel free to contact Dan O’Brien or any member of our health care practice group for a further discussion.

OIG 2014 Work Plan – Hospice

This article represents another installment of a series of articles that will outline the OIG’s activities, as discussed in the 2014 work plan, for a specific industry sector – hospice.

For 2014, the OIG’s activities relating to hospices are focused on the provision of hospice services in assisted living facilities, and quality of care.

Hospice in Assisted Living Facilities

Pursuant to the Affordable Care Act, CMS is required to reform the hospice payment system, collect data relevant to revising hospice payments, and develop quality measures for hospices. Hospice care is currently provided in a variety of settings, including private residences, skilled nursing facilities, and assisted living facilities. Continue reading

OIG 2014 Work Plan – Skilled Nursing Facilities

Recently, the Department of Health and Human Services Office of the Inspector General (the “OIG”) released its work plan for 2014. The work plan provides stakeholders in the health care industry with a broad overview of the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during the year. This article is one in a series of articles that will outline the OIG’s activities, as discussed in the 2014 work plan, for a specific industry sector – skilled nursing facilities.

For 2014, the OIG’s activities relating to skilled nursing facilities are focused on billing and payments and quality of care. Continue reading

CMS Directs MACs to Reject Part B Ambulance Claims for SNF to SNF Transfers

On November 6, 2013, CMS issued Transmittal No. 1311 which instructed Medicare Administrative Contractors (“MACs”) to reject claims for SNF to SNF ambulance transfers that are billed separately under Part B. According to CMS, ambulance transportation and related ambulance services for residents in a Part A stay are included in the SNF PPS rate and may not be billed as Part B services by the supplier. Instead, the SNF discharging the beneficiary to another SNF is responsible for the transportation fees. As such, ambulance providers must seek payment from the transferring SNF. Continue reading

Ohio Delays ICDS Program Launch Date

Last week, Ohio Medicaid Director John McCarthy announced that the launch date for voluntary enrollment in MyCare Ohio (fka as Ohio’s Integrated Care Delivery System) will be delayed until March 1, 2014.  The announcement was made during Director McCarthy’s recent testimony before the Joint Legislative Commission for Unified Long Term Care Services and Supports. Continue reading

OIG Publishes Special Fraud Alert regarding Physician-Owned Distributors (“PODs”) – Describes PODs as “Inherently Suspect”

Over the last several years, there has been a noted proliferation in the growth of physician-owned distributors (“PODs”). Along with this growth has come increased scrutiny and speculation as to the legality of PODs, with highly vocal critics and proponents on both sides of the debate. In fact, the Office of the Inspector General’s (“OIG”) 2013 Work Plan noted that the OIG planned to examine PODs in connection with reports of high utilization of spinal implants by hospitals associated with PODs.

Accordingly, on March 26, 2013, the OIG released a Special Fraud Alert (the “Fraud Alert”) which provides long-awaited guidance concerning the legality of PODs. Continue reading

OIG: Skilled Nursing Activities in the 2013 Work Plan

On October 2, 2012, The U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) released its Work Plan for 2013. The OIG releases its work plan for each year in advance of the coming year. The work plan provides stakeholders in the health care industry with a broad overview of the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will review and evaluate during that fiscal year. This client alert is the second in a series of alerts that will outline the OIG’s activities, as discussed in the 2013 Work Plan, for a specific industry sector – Nursing Homes.

The OIG’s activities relating to Nursing Homes for 2013 are focused on quality of care, although investigations concerning questionable billing patterns are once again identified as a priority. Continue reading