Time is on My Side: Getting Ready for the CoP Challenge

On Friday, CMS announced a delay in the new Home Health Conditions of Participation (CoP) until January 2018. That should come as no surprise to anyone since, as of today, we have no interpretive guidelines and surveyors have not been trained regarding the new Rule.  Just like in that Rolling Stones song “Time is on... Continue Reading →

Pre-Claim Review (PCR) – Be Careful What You Wish For

That was close, Florida. Literally hours before implementation, Florida home care agencies received the news they were hoping for.  A long-awaited hold has been placed on pre-claim reviews (PCRs) in Florida and a pause has occurred in the state of Illinois. After months of laboring with a poorly prepared Palmetto in Illinois, agencies in that... Continue Reading →

Home Health PCR Suspension Announced Today!             

Late Friday afternoon, CMS announced that effective April 1, 2017, PCR will be paused for Illinois at least for 30 days. In addition, PCR will not begin on April 1, 2017, in Florida, as previously planned.  This news follows a meeting with the new CMS Administrator, Seema Verma and several providers from both Illinois and... Continue Reading →

CMS Proposes Delay in the HHCoPs

Our industry received a slight delay in the implementation of the Home Health Conditions of Participation. This proposed delay is to be effective January of 2018.  Providers should use this time to begin training on the new CoPs and to begin setting your agency up for compliance. Take this opportunity to attend QIRT’s two-day event... Continue Reading →

Probe and Educate Strategy Continues

CMS Announces a Continuation of the Home Health Probe and Educate Medical Review Strategy In the December 16, 2016 MLN Release (SE1635), CMS announced that Medicare Administrative Contractors (MACs), in conjunction with CMS, have initiated Round 2 of the Probe and Educate Strategy for home health providers. This will be effective on or after December... Continue Reading →

PCR Update: Palmetto Moving Forward Texas and Florida to Begin Testing eService Portal Now

Last week, Palmetto announced that Texas and Florida providers could begin testing the Pre-Claim Review (PCR) eService Portal for submissions of PCR claims. This is the first indication that CMS intends to move forward with pre-claim review in the remainder of the five states previously identified. As of November 28, 2016, National Government Services (NGS)... Continue Reading →

Pre-Claim Reviews: Curse or Cure?

Pre-claim reviews (PCR) have caused quite a panic in the home care industry recently. QIRT consultants have been hearing terms such as “a big mess, chaos, etc.” used to describe this new process. PCR is, indeed, a change in the way agencies should be looking at the documentation showing actual beneficiary eligibility and unique care... Continue Reading →

Summary of the Final Rule for HH PPS Rate CY2017

The end of October ushered in the release of the Centers for Medicare & Medicaid Services (CMS) Final Rule for the CY2017 Home Health Payment (CMS-1648). On the surface, it appears payment will increase for 2017 since the base rate increases in 2017 to $2989.97 from the 2016 base rate of $2965.12. On the surface,... Continue Reading →

The Future of Home Health Reimbursement

For many years, home health care experts have heard the rumblings…we have seen the signs. As an industry, we have known that eventually we would see another drastic change to the established reimbursement model. Even so, there are many who will not make preparations to move toward a methodology change until there is an effective... Continue Reading →

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