Articles

Home Health Providers and rehab clinicians have certainly garnered the focus of CMS contractors currently auditing for qualified and skilled care content in homecare episodes, and the level of specificity of the audits reveals an entirely new standard for qualified care in these areas of our programs. In addition, the expectations for therapy service delivery […]

Topic: Zone Program Integrity Contractors (ZPICs) Concern: ZPIC Audits Question: ZPIC Audits—Are you ready??? In a statement by CMS, “The ZPIC program will focus on quick response to fraud and administrative actions. ZPICs may take action to ensure that Medicare trust fund monies are not inappropriately paid and that any mistaken payments are recouped. The […]

Home Health reform, and healthcare reform in general, promotes improved clinical outcomes through evidence-based care advances. As the care continuum continues to evolve in response to lessons learned over the last quarter century, homecare Providers and clinicians will be challenged to remain current in their care program production and delivery. New clinical protocols, patient management […]

The Medicare Payment Advisory Committee (Med Pac) released their annual Report to the Congress last Thursday, outlining proposals for payment policy recommendations that will affect many different types of Medicare fee-for-service Providers. Home Health concerns identified by previous Med Pac opinions are addressed front and center, and homecare Providers will find themselves on an entirely […]

The new year has brought stories regarding unprecedented levels of audit activity throughout various parts of the country, including regions not normally associated with utilization concerns. Pre-payment reviews from Palmetto, requesting ADR charts as part of sample probes, have been reported recently in Indiana, Ohio, and Florida; and other Medicare Administrative Contractors (MACs) are expected […]

Home Health Providers find opportunities for the future and answers to CMS reforms in the progressive UR program S.U.R.C.H. As Home Health providers begin the New Year, challenged by the mounting pressures confronting the homecare industry, many describe feelings of anxiety as they prepare to navigate an uncertain future. Funding cuts, coding changes, therapy payment […]

The 2012 PPS Proposed Rule outlines Medicare Home Health refinements in the latest CMS installation of the care and quality controls that have redefined the benefit. The changes involve the expected funding cuts provided in the form of case-mix modifications and reductions in the market basket update (see 8/8/11 HHSM Newsletter). Also included was the […]

Regular readers of the HHSM Newsletter are familiar with the Home Health programming tool S.U.R.C.H. – Service Utilization Review for Care in the Home, and the potential for homecare providers to control programming through use of this progressive clinical management methodology. Today, we recount the story of an Iowa Home Health agency who realized considerable […]

CMS’ recent release of the Home Health PPS Proposed Rule outlines the latest attempts to redefine the homecare model with an eye on the sort of cost and quality controls that are employed to manage care content and volumes from other Medicare provider-types. In a manner similar to the refinements seen throughout the rest of […]

If you listen closely, you can almost hear a collective sigh of relief from Home Health agencies and clinicians as they complete preparations and modifications in response to the 2011 PPS Rule. The gradual introduction and confusion initially surrounding the rule, combined with delays of the face-to-face and therapy requirements, have presented homecare providers and […]