CMS proposes to resume pre-claim demo, potentially expand it to more states

Brought to you by Home Health Line.
CMS is seeking public input into relaunching a pre-claim review demonstration for home health services. States that are potentially affected are located within the Medicare Administrative Contractor (MAC) Palmetto GBA’s jurisdiction.
“CMS proposes initially implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas with the option to expand to other states in the Palmetto/JM jurisdiction,” CMS says in a comment request posted on the Federal Register website May …

CMS shifts from denials to RTPs for home health claims with no matching OASIS

The following story is from Home Health Line.
Home health agencies will now have their claims returned when Medicare systems fail to match those claims with a corresponding OASIS assessment.
Based on new requirements that went into effect in April, agencies started receiving denials when a claim was submitted, but a matching OASIS could not be found.
On Oct. 12 CMS announced this situation will no longer result in an automatic denial, but instead CMS will Return …

Home health device provider to pay for improper billing

Apria Healthcare, which makes home healthcare devices, has been ordered to pay $750,000 to resolve obligations that they billed patients that were already covered by MassHealth, Massachusetts’ state insurance program.
The State Attorney General’s office told WWLP.com that between December of 2011 and April of 2017, some 1,000 MassHealth members were inappropriately billed, and of those, about 500 had paid Apria.
The settlement ensures patients will get their money back.
Source: WWLP.com

Understand special SNF billing cases to avoid claims rejections

Editorial Note: This post is an excerpt from HCPro’s title Consolidated Billing for Long-Term Care by Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC
Often times, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive billing processes within the skilled nursing facility (SNF). The below information will help providers lay the foundation for a comprehensive billing system that safeguards against these pitfalls by highlighting one special consolidated billing (CB) case involving services …