Dr. Jacques Roy certified more patients for Medicare home health eligibility than any other physician’s clinic in the country. Most of them received no services though millions of dollars in claims were generated, and paid, in their names. By the time Roy’s fraudulent operation was exposed and he was indicted this week, 78 home health care companies had their Medicare billing privileges suspended and 500 others were named as participants in the scheme.
Colorado home care providers are celebrating this week over nine dollars and forty-five cents. Beginning February 1, agencies may bill Medicaid for providing home telehealth care. Read here how they got there after more than six years of hard work and about the new law’s specific conditions.
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced Wednesday that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.
There is still time to register for CMS-sponsored, free ACO Learning Sessions, set for Monday, June 20 through Wednesday, June 22, 2011 in Minneapolis, Minnesota.
— Approximately $40 million in Affordable Care Act funds for statewide chronic disease prevention programs. State and territorial health departments may submit grant applications.
— CMS Announces National Version 5010 Testing Days
— CMS Seeks Comments on Vascular Readmissions Measure
“If your CEO answers your question about how to prepare for the conversion from ICD-9 to ICD-10 coding by saying, ‘I’ve already assigned that to the IT department,’ you hereby have my permission to tell him, or her, ‘Are you kidding me?’” With this, two experts, one an RN and the other a CPA offered a live audience a firm warning: get started NOW.
“More frequently than chance would dictate, denial letters dispose of just enough visits to kick a full-pay episode down to a LUPA. When there were seven visits, they deny three; when there were five visits, they deny one. Rarely if ever do agencies see a seven- or ten-visit episode reduced to five.”
Have you spoken with your software vendor yet about their plans for the HIPAA 5010 claims transaction sets? Testing begins in January, with implementation one year later. After that, CMS claims, ICD-10 will arrive on time in 2013, and it will be obligatory for all HIPAA covered entities, not just those that submit claims to Medicare and Medicaid.
CMS keeps changing the PECOS deadline. Will your July claims be denied or not? Uncertainty is frustrating. Home care agencies and their referring physicians just want CMS to get the online application system working and make up their mind about when they will enforce it. One by one, we are hearing about software vendors coming to the rescue. This story about one of them, ContinuLink, includes a comprehensive history of PECOS’s fluid deadlines.
We also reprint verbatim CMS’s July 16 announcement of and rationale for its proposed 4.75% Home Health PPS rate reduction. If you have your own copy of the announcement and noticed that the link to the July 23 Federal Register is incorrect, check the end of this article for the correct one.
Included as well is the pertinent excerpt from the FR describing instructions for delivering your comments to CMS.
