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CCJRM Threatens Home Health with Prior Authorization

Beth Noyce

Stick figure on crutches

The Comprehensive Care for Joint Replacement Model that begins April 1, 2016 is a CMS demonstration that proposes to adopt prior authorization processes and bundle home health reimbursement with the acute care hospitalization costs.

Withholding Home Health Maintenance Care: Illegal

Beth Noyce

CMS is not complying with the class-action Jimmo v. Sebelius settlement of 2013 requiring CMS to stop Medicare providers from denying medically necessary maintenance nursing and therapy to beneficiaries, including those who qualify for home health services. 

The Center for Medicare Advocacy announced March 1, 2016 that the plaintiffs' attorneys, the Center for Medicare Advocacy, and Vermont Legal Aid filed a Motion for Resolution of Non-compliance with the Settlement Agreement asking Vermont Chief Judge Christina Reiss to enforce CMS' promise to end the illegal practice.

The Whats, Whens, & Hows of Repaying Agency-Discovered Overpayments to CMS

Woman with tablet

During a spot-check quality audit, you discover that the documentation in the patient record doesn't support the amount Medicare paid for the claim. Alarmed, you search the record for any misfiled documents and ask those involved with the patient's care if key information was documented correctly. After your frantic search it is clear that Medicare overpaid your agency for the services in a payment episode several months ago.

Yikes! You know the agency must repay Medicare. But isn't it too late? Was accepting the overpayment in the first place fraudulent?

Send Home Health & Hospice ICD-10 Coding Questions to the AHCC

Beth Noyce

Comments 4 Tags diagnoses, diagnosis, home care, hospice, ICD-10

Young man with laptop

Got questions about ICD-10 diagnosis coding for hospice or home health?

Email your queries to the Association for Home Health Coding and Compliance (AHCC) at:, Subject Line: ICD-10 Workgroup question.

Until recently, diagnosis coders had no option but to request official diagnosis coding guidance and clarification from CMS' designated coding gurus at the American Hospital Association's (AHA) "Coding Clinic." But hospice and home health agencies report receiving conflicting and/or inapplicable guidance that could lead to payment delays or claim denials.

Download your free OASIS-C2 Item Set & Video

Beth Noyce

Comments 5 Tags home care, oasis, OASIS-C2

Prepare now for OASIS-C2. Download your free OASIS-C2 Item Set pdf, and watch my free video introducing the changes you can expect come
January 2017.
In the spirit of the nostalgic new X-files mini series, the truth is out there. Know it.