In a press release, CMS announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The Quality Payment Program has two tracks you can choose:Advanced Alternative Payment Models (APMs) orThe Merit-based Incentive Payment System (MIPS)The data submission system is an improvement from the former systems under the CMS legacy programs, which … [Read more...] about CMS Launches Data Submission System for Clinicians in the Quality Payment Program
CMS cancels planned Home Health Groupings Payment Model, announces new rule
CMS announced in a rule that it would not move forward with the Home Health Groupings Model. These regulations are effective on January 1, 2018. According to CMS, this final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. The … [Read more...] about CMS cancels planned Home Health Groupings Payment Model, announces new rule
When Dying is Profitable. Practice of Hospice patients being discharged before death linked to higher profits for facilities
In the past years, there has been a major increase in for-profit hospices and according to a study published last month in the journal Health Affairs titled: “A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death.” The study was researched from a sample of 1,439 freestanding hospices, as well as for-profit, chain-owned and nonprofit facilities, and their live discharge rates. The report found that live discharge rate rose from 2000 t0 … [Read more...] about When Dying is Profitable. Practice of Hospice patients being discharged before death linked to higher profits for facilities
Approved Rate Reductions in the HCS and TxHmL Waiver Programs (Effective August 1, 2017)
Information Letter No. 17-16 - Effective August 1, 2017, The Texas Health and Human Services Commission (HHSC) has listed its new and approved payment rate changes (decrease in payment rates) for the following providers as identified in the below list. HHSC has exempted the rates for the Consumer Directed Services (CDS) option from these rate reductions. All providers should share with any CDS employers to whom they provide any HCS or TxHmL services that the CDS option is specifically exempted … [Read more...] about Approved Rate Reductions in the HCS and TxHmL Waiver Programs (Effective August 1, 2017)
Preparing for the Upcoming Fiscal Year 2017 Fee-for-Service Claims Billing Closeout
Information Letter No. 17-13 - This letter is addressed to all service providers, facilities, and agencies. August 31, 2017 is the end of fiscal year closeout and it is important for all providers to promptly submit claims to be paid by the Texas Health and Human Services Commission (HHSC) for any unbilled services. HHS will publish additional details regarding cutoff dates for fiscal year 2017. This information letter addresses the following:12-month filing rule - Providers should ensure not … [Read more...] about Preparing for the Upcoming Fiscal Year 2017 Fee-for-Service Claims Billing Closeout
Medicaid Managed Care Fraud and the New Rule
The final rule has been recently issued. Suffice it to say that it is long and complicated. Expect increased enforcement and prosecutor scrutiny. I will write a series of articles trying to parse out the complexities, risks and best practices in the coming months. In the meantime, read the 2016 OIG Work Plan for the purpose of your compliance plans. … [Read more...] about Medicaid Managed Care Fraud and the New Rule
Consumer Directed Services Budget Workbook Revisions to Accommodate Rate Changes for the CBA Program
The purpose of the letter is to provide direction to Financial Management Services Agencies (FMSAs) on updating Consumer Directed Services (CDS) employers’ budgets to accommodate the new payment rate, effective March 1, 2014, for Community Based Alternatives (CBA) Personal Assistance Services (PAS). The Health and Human Services Commission approved rate can be found in Information Letter No. 14- 16. The rate change for CBA PAS requires a service authorization change. By May 30, 2014, the … [Read more...] about Consumer Directed Services Budget Workbook Revisions to Accommodate Rate Changes for the CBA Program
RUG Reviews: The Exit Conference
http://youtu.be/aZNMNvHJYgc At the conclusion of the onsite review, the HHSC-OIG nurse reviewer must hold an exit conference with the nursing staff. The Administrator, DON, charge nurse and other leadership of the facility should attend in order to gain a full understanding of the findings by the nurse reviewer. The nurse reviewer is mandated to provide “formal written notification of all MDS validation findings during the exit process.” You will receive a “List of … [Read more...] about RUG Reviews: The Exit Conference
The New Star Chambers
And you thought they were abolished for good by the Long Parliment. Think again. (Caution, bad language) … [Read more...] about The New Star Chambers
The Return of Debtor’s Prisons
As this article states, Debtors Prisons were abolished in America in the 1800's. Collection companies are now using courts as their personal debt collection agencies by having debtors thrown in jail based on contempt charges for missing hearings. The rub? The collection companies are effecting this by failing to give debtors notice of the hearings! The question I have? WHY AREN'T THE JUDGES SUFFICIENTLY VETTING THE NOTICE ISSUE?! One solution? We have elections coming up. Find out … [Read more...] about The Return of Debtor’s Prisons
