House and Senate finally agree on budget blueprint. By a slim margin, the U.S. House and Senate have agreed on a non-binding budget resolution that calls for $10 billion in Medicaid cuts over five years.
Originally, the House called for $20 billion in Medicaid cuts while the Senate approved no cuts (see Eli's HCW, Vol. XIV, No. 12, p. 95). But budget negotiators finally agreed on the $10 billion cut after concessions were made, including establishing a commission to examine Medicaid issues, according to press reports.
Medicaid cuts are bad enough news for home care providers. But the budget blueprint doesn't require lawmakers to stick solely to Medicaid to trim costs.
"While the lack of Medicare cuts is a positive sign to providers, a risk remains that the House Ways and Means and the Senate Finance Committees may seek cuts from certain [Medicare] providers if legislation moves forward to reverse scheduled cuts to physician payments," warns the National Association for Home Care & Hospice.
The outpatient therapy cap is another area that could leave legislators seeking funding cuts, cautions the American Association for Homecare. "To offset increased spending related to these two problems, they will be seeking between $25 billion and $40 billion over five years in program reductions elsewhere," AAH says.
The likelihood of pay for performance for home care just got stronger. Reports from the hospital P4P demonstration project's first year show that outcomes improved from three to 12 percentage points in all five clinical areas tracked in the demo, the Centers for Medicare & Medicaid Services says.
And CMS seems eager to spread the success to other providers. "These early returns demonstrate that using financial incentives to reward better quality patient care works to deliver better care and avoid costly complications for our patients," CMS Administrator Mark McClellan says in a release.
Ignore CERT record requests at your own financial peril, CMS reminds providers in a recent Medlearn Matters article. If you don't promptly provide supporting documentation for a comprehensive error rate testing review, the contractor will consider your claim an error.
If a CERT contractor decides your claim is "erroneous" because you failed to submit requested documentation, Medicare will send you a letter demanding that you refund the claim, CMS says.
You don't need to obtain your Medicare patients' specific authorization to forward their medical records to a CERT contractor, nor is this disclosure a violation of HIPAA, CMS stresses.
The Medlearn Matters article is at
www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0526.pdf.
Adminastar Federal wants to make suppliers' lives a little easier. To that end, the Region B durable medical equipment regional carrier's Payment Correction Unit is now allowing suppliers to fax requests for immediate offsets. For a copy of the form, [...]
