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OIG Adds 2 Home Health Items to Work Plan

Beth Noyce

The office of Inspector General is looking into how home health deals with pandemic issues. I wanted you to know about this. The Office of Inspector General (OIG) has announced two new items of interest to NAHC home health members. One is an audit of home health telehealth services during the COVID-19 public health emergency (PHE) and the second is a report on the challenges faced by home health agencies in responding to the PHE and the strategies used to respond. Audit of Home Health Services Provided as Telehealth During the COVID-19 Public Health Emergency The declaration of a public...


CMS Finalizes Definition of “Reasonable and Necessary”

Beth Noyce

The phrase "reasonable and necessary" has long been embedded in coverage descriptions in the Medicare Benefit Policy Manual and the Medicare Program Integrity Manual as guidance for providers. But it  wasn't codified as law until January 14 when the Federal Register posted the final rule Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary.’’  NAHC unpacks this in the article below. CMS Finalizes Definition of “Reasonable and Necessary” A definition of “reasonable and necessary” is part of the recently finalized rule,  Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary’’.   As previously reported this rule...


New Court Decision on Recoupments Before ALJ Hearings

Beth Noyce

Awaiting a hearing before an Administrative Law Judge just got potentially much more expensive. "Now . . . providers have a much tougher “roe to hoe” in order to stop recoupments before ALJ hearings," says Elizabeth E. Hogue, Esq.  in her article below.  The Court reversed its previous decision in Adams EMS, Inc. v. Azar [No. H-18-1443 (S.D. Tex. July 11, 2018)] and decided that Adams EMS was not entitled to a hearing before an ALJ before recoupment of an overpayment by the Centers for Medicare and Medicaid Services (CMS) Adams EMS, Inc. v. Azar [Civil Action No. H-18-1443, United States District Court, S.D. Texas,...


What About Gifts Cards and Gift Certificates?

Beth Noyce

  This anti-kickback clarification could keep your staff out of jail. I wanted you to see it. What About Gifts Cards and Gift Certificates? A key question for providers, especially marketing staff members, is whether they can give referral sources gift cards or gift certificates. This question is equally important for referral sources that may be offered gift cards or gift certificates by providers to which they make referrals. The answers to these questions are based on the federal antikickback statute, which says, in part:   "(1) Whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate)...


OCR Issues Guidance on HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes

Beth Noyce

When important government data comes out, I want you to know about it. Here's an article NAHC published January 5. OCR Issues Guidance on HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes On Friday, December 18, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidance on how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) permits covered entities and their business associates to use health information exchanges (HIEs) to disclose protected health information (PHI) for the public health activities of a public health...