Literature Review
All posts tagged with “Regulatory News.”
The states where most Medicare beneficiaries have Medicare Advantage plans
03/11/24 at 03:00 AMThe states where most Medicare beneficiaries have Medicare Advantage plans Becker's Payer Issues, by Andrew Cass; 3/6/24 Twenty-six states now have more than half of their Medicare enrollees in Medicare Advantage plans, according to a March 5 report from Chartis, a healthcare advisory services firm. Nationwide, half of Medicare-eligible beneficiaries are now enrolled in Medicare Advantage plans. [Click on the title's link for] the 26 states where Medicare Advantage market penetration exceeds 50%.
Frontline hospice staff need to understand new CMS survey methods
03/11/24 at 02:00 AMFrontline hospice staff need to understand new CMS survey methodsHospice News, by Holly Vossel; 3/5/24Ensuring staff are educated around revisions to hospice survey processes will be key to navigating ongoing regulatory changes in the industry. This year will bring further implementation of survey validation activities, but also new regulatory oversight processes, according to Kim Skehan, vice president of accreditation for the Community Health Accreditation Partner (CHAP) organization.
Wound coding changes bring compliance, legal questions
03/07/24 at 03:30 AMWound coding changes bring compliance, legal questions McKnights Long-Term Care News, by Josh Henreckson; 3/5/24 Changes to end-of-life wound classification in a recent Minimum Data Set update should be a positive for long-term care, but regulatory and legal ambiguity still surrounded the new coding procedures at press time.
MA’s cost-management tools may be hurting home healthcare quality, outcomes
03/07/24 at 03:00 AMMA’s cost-management tools may be hurting home healthcare quality, outcomesMcKnights Long-Term Care News, by Adam Healy; 3/5/24Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care, according to one home healthcare leader.
CMS offers relief to providers affected by Change Healthcare outage
03/07/24 at 03:00 AMCMS offers relief to providers affected by Change Healthcare outageModern Healthcare, by Lauren Berryman; 3/5/24The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.Editor's Note: Access to the full article requires a subscription
A whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing?
03/06/24 at 03:00 AMA whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing? Delaware Online, by Esteban Parra and Xerxes Wilson; 3/4/24A former medical director specializing in neurosurgery at southern Delaware’s largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified “brain-dead” patients in order to overbill for services. ... [The whistleblower reported that] hospital officials discussed a "new hospital initiative" in which suspected "brain-dead" patients would be discharged and admitted to hospice before any declaration of brain death, according to the lawsuit. The scheme allowed for prolonged billing where previous billing ended with the patient’s death, the complaint states. [Please refer to the article for details.]
The top strategies healthcare organizations can use to reduce denials
03/06/24 at 03:00 AMThe top strategies healthcare organizations can use to reduce denials MedCityNews, by Laxmi Patel; 3/5/24Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.
Providers meet with OMB to prevent ‘devastating’ effect of 80/20 provision
03/06/24 at 03:00 AMProviders meet with OMB to prevent ‘devastating’ effect of 80/20 provision McKnights Home Care, by Adam Healy; 3/4/24Home care stakeholders have been busy on Capitol Hill voicing concerns about a controversial provision of the proposed Medicaid Access Rule. The National Association for Home Care & Hospice and Home Care Association of America met with the Office of Management and Budget last week to discuss the Access Rule’s so-called 80/20 provision. The provision, if finalized, would require that 80% of Medicaid payments for personal care, home health and homemaker services be spent on workers’ compensation. “If that one provision is finalized as proposed, it would be so detrimental that we’d likely lose a significant portion of our service delivery base and people would go without care,” Damon Terzaghi, NAHC’s director of Medicaid HCBS (home- and community-based services) said in an interview with McKnight’s Home Care Daily Pulse. “It would truly be devastating.”
Coverage denials in Medicare Advantage—Balancing access and efficiency
03/06/24 at 03:00 AMCoverage denials in Medicare Advantage—Balancing access and efficiencyJAMA Health Forum; by Suhas Gondi, MD, MBA; Kushal T. Kadakia, MSc; and Thomas C. Tsai, MD, MPH; 3/1/24 Each year, millions of claims for medical services are denied by health insurance plans. Many denials may be justified as a necessary strategy to reduce wasteful spending from low-value care. However, denials may also delay diagnosis and/or treatment for patients, and appealing denials contributes to clinician workload and burnout. This tension is apparent in the Medicare program, where denials affect millions of beneficiaries who enroll in Medicare Advantage (MA).
Medicare’s new Dementia GUIDE Model: How can physicians, hospices, and home health agencies participate?
03/05/24 at 03:00 AMMedicare’s new Dementia GUIDE Model: How can physicians, hospices, and home health agencies participate? Morgan Lewis Blog Post; 3/1/24If you have had a loved one suffer from dementia, you know the emotional, physical, and financial toll of this terrible disease. With advancements in dementia treatment, however, there is renewed hope on addressing this disease and increasing emphasis on fostering innovative care models. A central pillar of this effort is the Guiding an Improved Dementia Experience (GUIDE) model, announced by the US Department of Health and Human Service’s Centers for Medicare & Medicaid Services (CMS) in July 2023. This initiative—a new voluntary, nationwide alternative payment model—is designed to support Medicare beneficiaries with dementia, as well as their caregivers.
Home health disparities: Medicare Advantage patients receive fewer visits, worse outcomes
03/05/24 at 02:00 AMHome health disparities: Medicare Advantage patients receive fewer visits, worse outcomes Home Health Care News, by Patirck Filbin; 3/1/24Home health patients under Medicare Advantage (MA) plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits, according to a new study.
What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry
03/04/24 at 03:00 AMWhat the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.
CMS upends Medicare Advantage supplemental benefits data reporting for payers
03/04/24 at 02:00 AMCMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.
Untangling the history, causes behind the precipitous home health aide utilization drop
03/01/24 at 03:00 AMUntangling the history, causes behind the precipitous home health aide utilization drop Home Health Care News, by Patrick Filbin; 2/28/24In the last home health proposed rule from the Centers for Medicare & Medicaid Services (CMS), the federal agency in charge of reimbursement rates sent out a request for information on home health aide utilization. Specifically, the agency wondered why Medicare-covered home health aide visits and utilization had fallen off a cliff over the last few decades. According to the Center for Medicare Advocacy, home health aide visits declined by 90% from 1998 to 2019.
False Claims Act - 2023 Year in Review
03/01/24 at 03:00 AMFalse Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).
The state where all hospitals are on track to earn new Joint Commission [Equity] Certification
02/29/24 at 03:00 AMThe state where all hospitals are on track to earn new Joint Commission [Equity] CertificationBecker's Clinical Leadership, by Erica Carbajal; 2/28/24All hospitals in Massachusetts are meeting a health equity accreditation standard that The Joint Commission introduced last year, making it the first state to be recognized for the accomplishment. ... Achieving the standard is the first step to obtain The Joint Commission's recently launched health equity certification, which all of the state's hospitals plan to earn by 2025, according to a joint news release from the Massachusetts Health & Hospital Association and accrediting body.
Value-based care now driving home-based primary care growth, experts say
02/28/24 at 03:00 AMValue-based care now driving home-based primary care growth, experts sayMcKnights Home Care, by Adam Healy; 2/27/24When Independence at Home (IAH), the Centers for Medicare & Medicaid Services’ home-based primary care initiative, concluded at the end of 2023, after more than a decade, it marked the end of an era. Over the period of the model, the rise of value-based care has given providers a wealth of opportunities to bring primary care into patients’ homes.
HCA Mission Hospital regains CMS compliance
02/27/24 at 03:00 AMHCA Mission Hospital regains CMS complianceBecker's Hospital Review, by Mariah Taylor; 2/26/24CMS found Asheville, N.C.-based HCA Mission Hospital in compliance with its plan of correction and recommended removing the immediate jeopardy designation, Blue Ridge Public Radio reported Feb. 23. The hospital's plan of correction to address serious deficiencies it was cited for in January focuses on improving policies and educating staff.
CMS updates Hospice Care Compare
02/27/24 at 02:00 AMCMS updates Hospice Care CompareCMS website; 2/22/24Hospice care dataset updates; updated 2/1/24, released 2/21/24.
[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says
02/27/24 at 02:00 AM[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice.
Planning Ahead: Medicare, Medicaid or Hospice for at-home care
02/23/24 at 03:00 AMPlanning Ahead: Medicare, Medicaid or Hospice for at-home careThe Mercury, by Janet Colliton; 2/21/24If you are seeking at-home care assistance for a family member that is paid either in full or in part by the government, you can find that the system is complicated and, unless your loved one fits within one of the designated categories, you may be limited to paying from your family member’s asset or your own. Here are some of the differences and criteria.Editor's Note: This concise, user-friendly article by a Certified Elder Law Attorney provides simple descriptions of this all-important information. What Hospice Medicare information does your staff need to know and use? What clarity do you provide to the public / community you serve?
How CMS’ rule could tighten accrediting organization oversight
02/22/24 at 03:00 AMHow CMS’ rule could tighten accrediting organization oversightModern Healthcare, by Mari Devereaux; 2/20/24Accrediting organizations may have to reduce their fee-based consultation services and prohibit survey participation for employees with ties to health facilities or face penalties for violating conflict-of-interest provisions if the Centers for Medicare and Medicaid Services sticks with recent oversight proposals.Editor's Note: Full access to this article requires a subscription.
Doctor convicted of $2.8M hospice Medicare fraud scheme
02/21/24 at 03:30 AMDoctor convicted of $2.8M hospice Medicare fraud schemeHomeCare; 2/20/24A federal jury convicted a California man for his role in a scheme to defraud Medicare by billing $2.8 million for hospice services that patients did not need. From October 2014 to March 2016, [John] Thropay fraudulently certified Medicare patients ... as having terminal illnesses that the patients did not have ... [in order to] bill Medicare for hospice services. In 2015, Thropay was listed as an attending provider for more hospice claims paid by Medicare than any other provider in the nation.
Reduced federal share may force state Medicaid programs to cut services, HCBS expert says
02/21/24 at 03:00 AMReduced federal share may force state Medicaid programs to cut services, HCBS expert saysMcKnights Home Care, by Adam Healy; 2/15/24The Congressional Budget Office this month released its “Budget and Economic Outlook” report for the coming decade. In its report, CBO predicted a roughly $58 billion drop in federal Medicaid outlays for 2024 compared to 2023 — a 9% decrease in federal Medicaid spending, due in part to fewer beneficiaries on states’ Medicaid rolls.