Medicare Compliance & Reimbursement

Contracts between hospitals and insurers cover virtually every facet of care, so be aware that a greater focus on quality might find its way into your paperwork.

Case in point: Blue Cross Blue Shield (BCBS) of Rhode Island and Care New England, a major hospital group in the state, reached a five-year plan that includes BCBS paying the hospital additional amounts based on quality measures. The two entities are reworking their contract to focus more on comprehensive, quality-focused reimbursements.

"We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos," Peter Andruszkiewicz, president and CEO of Blue Cross, explained in a statement.

The new contract, which Andruszkiewicz says will likely be effective by the end of September, will define specific metrics based on quality-related programs, including creation of a more patient-centered model for both maternity care and for behavioral health, according to Providence Business News.

CMS Delays POS Rule until April 2013

CMS has delayed implementation for the POS rule you reference. The new effective and implementation date is April 1, 2013. CMS also added some revisions and clarifications to the rule regarding global diagnostic services, determining payment locality, and inpatient and outpatient services.

For instance: To report global 71010 (Radiologic examination, chest; single view, frontal), meaning without modifier 26 (Professional component) or TC (Technical component), the claim should reflect the ZIP code of the testing facility that performed the X-ray. And you may report the global code only when the same physician/supplier performs both the TC and PC, and the TC and PC are furnished in the same fee schedule locality.

There’s an MLN Matters article on the topic at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7631.pdf.

Practice Size Doesn’t Matter When It Comes to HIPAA Settlements

If you think your practice will never be investigated over a HIPAA breach because "they’re only coming down on the big guys," then think again. Although all of the previous HIPAA settlements have involved breaches by bigger health organizations that impact more than 500 patients, HHS recently announced a $50,000 settlement with a hospice that involved 441 patients.

The hospice organization revealed to HHS that an "unencrypted laptop computer containing the electronic protected health information (ePHI) of 441 patients had been stolen in June 2010," the HHS’s Jan. 2 news release noted. Once HHS got involved, the agency discovered that the hospice had never conducted a risk analysis to safeguard ePHI, nor did the hospice have policies in place to address mobile device security as required by the HIPAA laws.

"This action sends a strong message to the health care industry that, regardless of size, covered entities must take action and will be held accountable for safeguarding their patients’ health information." said OCR Director Leon Rodriguez in the statement. "Encryption is an easy method for making lost information unusable, unreadable and undecipherable."

To read the complete release, visit www.hhs.gov/news/press/2013pres/01/20130102a.html.

MACs Focus on Medicare Payments for Illegal Immigrants

Medicare payments for illegal immigrants are under the microscope, as the OIG identified certain "overpayments" for beneficiaries who were unlawfully present in the United States for a period of time, reports Palmetto GBA. This glitch could occur when the Social Security Administration is slow to update its records of beneficiaries’ residential status, and thus the Medicare files are late in updating.

CMS is now requiring Medicare Administrative Contractors to collect any 2009 paid claims where the beneficiary was illegally present in the United States at the time the provider rendered services. If your MAC finds such overpayments, you can appeal the claim denial by requesting a redetermination via the normal appeals process.

Louisiana Eliminates Medicaid Coverage for Hospice Care

Effective Feb. 1, Louisiana will cut Medicaid payments for hospice care, along with other Medicaid cuts as part of severe state budget cuts, reports TheAdvertiser.com. Of course, hospice care in Louisiana will still be covered under Medicare, but there are thousands of Medicaid patients in the state seeking hospice care -- nearly 6,000 in fact.

The understanding is that nursing homes and HHAs will pick up the slack for Medicaid beneficiaries who can no longer enlist hospice services. Louisiana’s elimination of Medicaid payments for hospice care comes on the heels of the budget axe falling on charity hospitals in that state.

Learn Expert Strategies For A Smooth ICD 10-CM Transition

Why wait until the last minute to devise your game plan? Prepare now for the big ICD 10-CM transition that will affect your home health agency in the next year. Remember -- big changes require big preparations.

Join expert speaker Andrea L. Manning, BS, RN, HCS-D, COS-C for a 60-minute live webinar, ICD 10-CM: Transition Strategies for Home Health Agencies, Wednesday, Feb. 6, 1 pm ET. Get concrete advice on what areas of your HHA’s operations the conversion to ICD-10 will affect and what you should be doing to prepare. Also, you’ll learn how to plan out a timeline for operational assessment, training and implementation.

You can even pose questions about your own unique situation during the Q&A session at the end of the webinar event. For more information, visit www.audioeducator.com/home-health/icd-10-transition-for-home-health-020613.html or call 1-866-458-2965.