Kenyon HomeCare ConsultingAre You Aware Of & Prepared For CMS Home Health Rulings, Proposals? - Kenyon HomeCare Consulting (206) 721-5091

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Are You Aware Of & Prepared For CMS Home Health Rulings, Proposals?

Home health organizations take note! Two new CMS home health rulings and one proposal have┬árecently been issued by The Centers for Medicare & Medicaid Services (CMS). Many home health organizations will be directly impacted by these decisions. And those not immediately affected should keep their ears perked for any whisper of change coming out of CMS. You never know which new rule will end up “rocking your homecare boat.”

CMS Home Health

Recent CMS Home Health Rulings/Proposal

The three new CMS home health developments recently released are as follows:

1. Coordinated Post-Acute Knee/Hip Replacement Care to Be Incentivized

In November of 2015, CMS made final a long-proposed program meant to incentivize post-acute care for those patients getting knee or hip replacements. Implementation begins in 67 hospitals and wraps all related care within 90 days of hospital discharge as “part of the same episode.” In effect, this encourages coordinated efforts between hospitals and home health organizations. There are limits, however. Cost of care cannot exceed a predetermined threshold without incurring “reconciliation fees” to the hospital. Still, within the threshold, everything is covered.

2. Patient Survey Star Ratings Will Affect Home Health Providers

CMS began to implement their new home health Patient Survey Star Rating system in January of 2016. This program is aimed at giving patients a voice in judging home health agencies’ overall performance. What’s more, the program ties your agency’s star rating to financial incentives from Medicare. While presently only active in 9 states, this Home Health Value program is likely to expand, so all home health providers should begin looking for ways to improve client care and “score” higher star ratings.

Some home health groups have expressed concern that the star ratings, which will first be published in July, will be misinterpreted by those viewing them online. The ratings are on a bell curve meaning a 3 rating equals the current industry average “at the moment” but does not indicate an pre-set standard of care. Thus, healthcare providers will need to educate potential clients on the meaning of the star ratings.

3. Proposed CMS Home Health Pre-authorization Requirement

In February of 2016, CMS announced a new proposal that would require home health agencies to get pre-authorization before they can see patients. If finalized, the Medicare Probable Fraud Measurement Pilot Program would be launched in five of the most fraud-prone states: Massachusetts, Michigan, Illinois, Florida, and Texas. These states had higher than 50% “improper payment” rates in 2014, This catch-all term includes more than just fraud and places these states in a negative statistical category.

The general idea of this proposal is to more minutely scrutinize claims before paying them when such claims are deemed, for various reasons, to have a high risk of fraud. The National Association for Home Care & Hospice (NAHC) believes if finalized, this proposal will needlessly increase administrative costs and unfairly harm many home health providers. Similar programs already exist, such as the pre-authorization required before CMS will pay out on power mobility devices (power scooters or wheelchairs).

Kenyon Consultants And CMS Home Health Changes

These three most recent, and any future, rulings or proposals from CMS can potentially affect your home health organization. It is crucial to be both aware of and prepared for their implementation. Kenyon Homecare Consulting, provides expert, knowledgeable consultants available to help you keep up to date on all the latest CMS home health changes. Contact us today to discuss how we can help!

Category: Legislation/Reform

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