Home Health Medicare and Medicaid Payment NetNews
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June 30, 2008
Medicare Conditions of Participation and Coverage
- Phase One of Manual Revisions to Reflect Payment Changes for Durable Medical Equipment, Prosthetic, Orthotics and Supplies (DMEPOS) Items as a Result of the DMEPOS Competitive Bidding Program
- Implementation of the 2007-2008 Update to the Medicare Wage Index Occupational Mix Survey (Form CMS-10079 (2008))
- National Competitive Bidding (NCB) for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Phase VII Correction of Common Working File (CWF) Category for Portable Oxygen
- Semiannual Regulatory Agenda Released
- Designation of Medically Underserved Populations and Health Professional Shortage Area
- Provider Authentication by Medicare Provider Contact Centers
- Blood-Derived Products for Chronic, Non-Healing Wounds
- Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process
- New Therapy Personnel Qualifications and Policies Effective January 1, 2008
- Instructions for Downloading the Medicare ZIP Code File for October 2008
Payments, Claims Filing and Cost Reports
- Correction to Determinations of Early vs. Later Episodes Under the Home Health Prospective Payment System (HH PPS)
- Medicare Advantage Program and Prescription Drug Benefits Program Revised
- Duplicate Medicaid and Medicare Home Health Payments: Medical Supplies and Therapeutic Services
- Policy Clarification on Part B Services Provided as Incident to Physician Services
- Billing Blood and Blood Products
- Update to the Medicare Secondary Payer Payment (MSPPAY) Module to Accommodate the Medicare Part A Claims Expansion
- July Quarterly Update for 2008 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
- Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.2, Effective July 1, 2008
Appeals
- Annual Adjustment in the Amount in Controversy (AIC) Threshold Amounts for Administrative Law Judge Hearings and Judicial Review Under the Medicare Appeals Process
- Provider Reimbursement Determinations and Appeals
- Hospice Conditions of Participation Extension of Timeline for Publication of Final Rule
Compliance
- Guidance to State Survey Agencies on Heparin Recall
- Updated Brochure on the Quality Indicator Survey
- Acceptance of Orders Using Physician Signature Stamp by Home Health Agencies and Hospices Banned
Medicaid
- Applications for Medicaid Benefits Denied Because Irrevocable Trust Assets Exceeded Medicaid Eligibility Limits
- Medicaid Waiver Program Requires Funding for Care in Home
May 30, 2008
Conditions of Participation and Medicare Coverage
- Annual Appellant Climate Survey Office of Medicare Hearings and Appeals (OMHA)
- Removal of Edits That Deny Claims for Parenteral or Enteral Services and/or Supplies if a Provider Has Not Recertified Medical Necessity
- Establishment of Pre-Payment Auto-Denial Edit for Use by Durable Medical Equipment Medicare Administrative Contractors in Applicable States for Suppliers of Oxygen and Oxygen Equipment
- Assignment of Providers to Medicare Administrative Contractors (MACs)
- Transition of Responsibility for Local Coverage Determinations (LCDs) From Durable Medical Equipment (DME) Program Safeguard Contractors (PSC) to DME Medicare Administrative Contractors (MACs)
- Update of Inflation Factors Used to Determine Reasonable Compensation
Payments, Claims Filing and Cost Reports
- Quarterly Update to Interest Rate on Overdue Debts
- Proposed Hospice Wage Index for Fiscal Year 2009
- Important Changes for Practitioners and Providers Under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
- Quarterly Update of Interest Rate for Medicare Overpayments and Underpayments
- Flagging Health Insurance Claim Numbers (HICN) in the Medicare Carrier System (MCS) for Pre-Payment Review/Audit
- New Process for Accessing Medicare Summary Notice (MSN) Messages and MSN Message File
- New HCPCS Codes for April 2008 Update
Appeals
- Administrative Appeals of Provider Enrollment Determinations
Compliance
- Treble Damages Penalty in Civil Actions Under False Claims Act
- Requirements for Felony Conviction of Durable Medical Equipment Suppliers and Physician for Healthcare Fraud and Payment of Illegal Kickback; Double Jeopardy Violation
Medicaid
- Financial Eligibility for Long-Term Care Assistance, Availability of Trust Property Not Spent for Sole Benefit of Disabled Beneficiary
- Guidance on Scope of Optional Home- and Community- Based Services Benefit
April 30, 2008
Medicare Conditions of Participation and Coverage
- Revised National Disaster Medical System (NDMS) Patient Treatment and Tracking Records System
- Approval of Continued Deeming Authority for the Community Health Accreditation Program for Home Health Agencies
- Approval of Continued Deeming Authority for the Joint Commission for Home Health Agencies
- Quarterly Listing of Program Issuances; October Through December 2007
- New OIG System of Records: Administrative Files
- Medicare Trustee Report
- Hospice Beneficiaries’ Use of Respite Care
- Overview of New Medicare Competitive Bidding Program for Durable Medical Equipment POS
- DMEPOS Competitive Bidding Program
- Release of the Revised CMS-855 Medicare Enrollment Applications
- Pre-bidding Activities for DMEPOS Bidding Program
- The President’s Proposed Legislative Response to the Medicare Funding Warning
- Clarification of Items in Chapter 10, “Healthcare Provider/Supplier Enrollment"
- New Contractor Numbers for the State of California Jurisdiction 1 Part B Medicare Administrative Contractor (MAC) Workload
- Update to Chapter 2, “The Certification Process,” Sections 2021 and 2022
Payments, Claims Filing and Cost Reports
- Correction to Low Utilization Payment Adjustment Add-on Payments Under the Refined Home Health Prospective Payment System (HH PPS)
- Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update
- Update to Chapter 3, Bad Debts, Charity, and Courtesy Allowances
- New Waived Tests
- Additional Clarification to Chapter 17, Section 40, Regarding Processing of Drug Claims with the JW Modifier
- April 2008 Integrated Outpatient Code Editor (I/OCE) Specifications Version 9.1
Appeals
- Termination of Provider Agreement for Failure to Safeguard Patient Information
Compliance
- Medicare Fraud Edit Module
- Model Letters for Provider Enrollment
- Signature Requirements Clarification
- Carrier Assignment of Provider Identification Numbers (PINs)
- Instructions on the Processing of CMS-855 Enrollment Applications Submitted Via the Web
Medicaid
- Vermont's Waiver Program
- Right to Challenge Reimbursement Rates Affecting Access to Care
- Forum for Enforcement of Federal Rights
- Medicaid Lien Against Workers’ Compensation Settlement
- Scope of Medicaid Lien Against Personal Injury Settlement
- Transfers of Assets and Medicaid Eligibility
- 2008 Update to Federal Poverty Guidelines
- Home and Community-Based State Plan Services
- Medicaid Rehabilitation Services
