On April 25, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued revision 113 to the State Operations Manual (“SOM”) governing skilled nursing and nursing facility survey and enforcement processes. Specifically, CMS updated the SOM Chapter 7 with an effective date of January 1, 2012 as the modifications were mandated by section 6111 of the Affordable Care Act of 2010. The major provisions related to guidance on the independent informal dispute resolution process; escrow of civil money penalty funds pending a formal appeal; a reduction of fifty percent (50%) for facilities that promptly correct self-reported non-compliance and guidance on the use of civil money penalty funds for the state agencies. As of today, the online CMS manual system does not include the updated guidance.
This guidance is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R113SOMA.pdf.
Posted in CMS Transmittals, Health & Human Services, Health Care, Health Care Providers, Long Term Care, Medicare, Nursing Facility, Participation, Regulatory Compliance, Skilled Nursing Facility, Survey and Certification Letters
In a recently released MLN Matters (Number: SE1417), CMS announced that it is implementing the enhanced enrollment screening provisions of the Affordable Care Act (ACA) by requiring finger print based background checks for certain so called “high risk” providers. Currently this means that for newly enrolling Durable Medical Equipment, Prosthetic, Orthotic and Supplies (DMEPOS) suppliers and Home Health Agencies, individuals with a 5% or greater ownership interest in the provider or supplier will be subject to criminal background checks based on fingerprint identification. The procedure will also apply to providers that CMS has elevated to the high risk category pursuant to regulations. Affected providers will be notified by their MAC and be given 30 days to comply. The notification will identify contact information for the Fingerprint Based Background Check Contractor (FBBC). Continue reading
Posted in Community Based Care, Compliance Programs, Durable Medical Equipment, Employee Background Checks, Fraud and Abuse, General, Health & Human Services, Health Care, Health Care Providers, Health Reform, Home Health, Medicare, MLN Matters, Participation, Program Integrity, Provider Enrollment - Medicare, Regulation, Regulatory Compliance
On February 20, 2014, the US Department of Health and Human Services, Departmental Appeals Board upheld CMS’ revocation of the Medicare provider number of a clinic/group practice.
In Advanced Care Medical Center v CMS (Docket No. C-13-1383/Decision No. CR3124), the DAB, Civil Remedies Division upheld CMS’ revocation of Advanced Care’s Medicare provider number.
The matter began with an investigation by the Office of the Inspector General which revealed that Advanced Care entered into a contract with a doctor, allowing him to bill for services under it’s billing number in exchange for a set reimbursement, and the doctor submitted bills under Petitioner’s billing number. Continue reading
Posted in Certification, Community Based Care, Compliance Programs, DAB Decisions, DHHS, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, Medicare, Out-Patient Care, Participation, Physicians, Program Integrity, Provider Enrollment - Medicare, Regulatory Compliance
On October 30, 2013, the New York State Office of the Medicaid Inspector General (“OMIG”) issued a press release that New York recovered $211 million from the federal government out of an identified $496 million in Medicaid erroneous payments related to home care recipients who are dually eligible for both Medicare and Medicaid funds. On October 1, 2013, the New York State Department of Health’s Fiscal Group received the $211 million payment through the action of OMIG, which was the largest single monetary recovery in OMIG’s history.
These payments were recovered by New York State as part of a federal project, the Third-Party Liability Home Health Care Demonstration Project, which is reviewing home health care involving dual eligible recipients, and is being conducted in conjunction with the University of Massachusetts Medical School. Continue reading
Posted in DHHS, Health & Human Services, Health Care, Home Health, Long Term Care, Medicaid, Medicare, New York, Nursing Facility, Nursing Home, Participation, Participation, Payers, Reimbursement, Skilled Nursing Facility
Tagged Centers for Medicare and Medicaid Services, CMS, Home Health, Medicaid, Medicare, New York, Nursing Home, OMIG, Skilled Nursing Facility, SNF
Earlier this month, the Centers for Medicare and Medicaid Services (“CMS”) released a policy memorandum announcing stricter Medicare certification practices for buyers of Medicare-participating providers opting to reject the automatic assignment of the seller’s Medicare provider contracts. When a purchaser is considering opting out of automatic assignment, it must carefully weigh the risk of reimbursement gaps with the benefit of reduced liability exposure. Continue reading
Posted in Certification, CMS Transmittals, Health & Human Services, Health Care, Health Care Providers, Medicare, Participation, Provider Enrollment - Medicare, Regulatory Compliance, Reimbursement, Survey and Certification Letters
On September 6th, 2013, in its Transmittal 2782, CMS announced the discontinuance of the use of the HHABN. Advance Beneficiary Notices of Noncoverage or ABNs are required to be issued by providers in order to inform medicare beneficiaries about possible non-covered services/charges. Transmittal 2782 announces that home health agencies (HHAs) will discontinue the use of HHABNs (Form CMS-R-296, the specific form for HHAs) and starting in December will use the ABN (Form CMS-R-131) for liability notification. The transmittal provides instructions for HHAs on the use of the ABN and also provides some clarification to the manual instructions on ABNs in Medicare Claims Processing Manual (Pub. 100-04), Chapter 30, Section 50.
You can find a copy of the transmittal at here –> CMS Transmittal 2782
Posted in CMS Transmittals, Community Based Care, Health Care, Health Care Providers, Home Health, Medicare, Participation, Payers, Post Acute Care, Regulatory Compliance, Reimbursement
In the April 5th Federal Register, the Center for Medicare and Medicaid Services (CMS) proposed new rules relating to immediate jeopardy situations for providers or suppliers that are not Skilled Nursing Facilities (SNFs) or Nursing Facilities (NFs). The proposed rules were published in April of 2013 in the Federal Register and generally apply to the oversight of accrediting organizations, but CMS also proposed a changed to the rule on providers and suppliers, other than SNFs and NFS, with deficiencies. Continue reading
Posted in Acute Care, Certification, Continuing Care, DAB Decisions, DHHS, Health & Human Services, Health Care, Health Care Providers, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care, Medicare, Nursing Facility, Nursing Home, Participation, Post Acute Care, Proposed Rule, Regulation, Regulatory Compliance, Rehabilitation, Rehabilitation Hospital, Residential Care, Skilled Nursing Facility