Health care advocates representing children, seniors and the disabled applauded the U.S. Supreme Court’s ruling upholding the Patient Protection and Affordable Care Act, affirming the constitutionality of the requirement that every American purchase health insurance.
OIG Studies Intermediate Sanctions for Home Health Review Provided Summary of Activity on HH Sanctions
The Office of Inspector General (OIG) recently completed a study on the status of home health sanctions as required by the Quality Standards for Inspection and Evaluation to ensure compliance with Medicare conditions of participation by home health agencies.
NAHC Report 2011. Copyright National Association for Home Care and Hospice, Inc (www.nahc.org) .— Reprinted with permission
NAHC Report Article
Tuesday, July 19, 2011
________________________________________ Congressional Panels Review the Independent Payment Advisory Board Members of Congress Discuss the Potential Impact on Seniors and Providers
The House Budget Committee and the House Energy and Commerce Health Subcommittee held hearings last week on the potential impact of the Independent Payment Advisory Board (IPAB) where Health and Human Services Secretary Kathleen Sebelius testified about its implementation and proposed models intended to contain health care costs and improve the solvency of Medicare.
The Centers for Medicare and Medicaid Services (CMS) are now conducting ZPIC audits. ZPIC’s are conducted by Zone Program Integrity Contractors. Unlike RAC audits that target identification of overpayment and CERT audits that attempt to pinpoint improper payments, ZPIC audits focus on fraud in the Medicare Program. This means that ZPIC contractors can audit the integrity of all Medicare claims, both pre- and post-payment.
On May 1, 2009, the Federal Trade Commission will begin enforcing its new Red Flags Rule. This Rule was created to ensure that certain types of organizations are doing everything in their power to identify, prevent, and reduce incidences of identity theft. The Rule is based on the perception that health care providers may have many opportunities in their day-to-day operations to discover the “red flags” of identity theft. Some health care providers, therefore, may be subject to this Rule, which requires that businesses develop identity theft Programs tailored to the characteristics and needs of their organizations.
It is especially important for management to guard against the use of tools that may support a conclusion that the agency encourages therapists to make decisions regarding the number of visits provided to patients based on enhanced reimbursement as opposed to clinical condition. There is a fine line to walk between educating therapists about how Medicare reimburses agencies so that staff members can be fiscally responsible and providing tools and reports to staff that spell out the financial implications of decisions regarding utilization. The latter is certainly to be avoided.