Posts Tagged ‘Medicare Advantage’

Date Set for Implementation of HIPPS Codes on Medicare Advantage Claims Delayed Again

November 15, 2013

The Centers for Medicare & Medicaid Services (CMS) has delayed, once again, the edit to reject Medicare Advantage (MA) plan claims that do not have a health insurance prospective payment system (HIPPS) code for home health services. The edits will not be activated until July 1, 2014. MA plans and the HHAs have until that time to make the necessary system adjustments.

CMS initially intended to require that MA plans include a HIPPS code on all home health encounters beginning July 1, 2013. The National Association for Home Care & Hospice (NAHC) contacted CMS in June to discuss concerns regarding the failure of the health plans to communicate this directive with the provider community. Several weeks after our call, CMS announced that were delaying the edit until December 1, 2013.

In a letter to the MA plans, CMS again announced delaying the edit for HIPPS codes on home health and skilled nursing facility encounters until July 1, 2014.

The letter states:  “MAOs and other entities were instructed that effective December 1, 2013 dates of service (DOS), the disposition for the HIPPS codes edits would be changed from ‘Informational’ to ‘Reject’ for any Skilled Nursing Facility (SNF) and Home Health (HH) encounters submitted without the appropriate HIPPS codes. The purpose of this notification is to let you know that the December 1, 2013 DOS ‘Reject’ edit will be delayed to July 1, 2014 DOS. The ‘Informational’ edit for HIPPS codes would remain in place until that time.”

Source: NAHC

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Medicare Advantage HIPPS Code Requirement Delayed

July 1, 2013

CMS has confirmed that the edit to reject Medicare Advantage plan claims for not having a HIPPS code for home health services will not be activated until December 1, 2013. Therefore, the MA plans and the HHAs have until that time to make the necessary system adjustments to place a HIPPS code on MA claims.

In addition, CMS has instructed the MA plans to communicate the HIPPS code requirements with HH providers so that they are able to make any changes to their systems. Agencies should contact their contracted MA plans for further instructions in complying with this requirement.  

Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

June 25, 2013

By Susan Jaffe, Kaiser Health News

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage – unless the problem got worse, in which case the treatment could resume.

This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage. (more…)

Update on HIPPS Codes on MA Plan Claims

June 24, 2013

In a conference call with CMS officials earlier this week, the National Association for Home Care & Hospcie learned that although the Medicare Advantage plans have been instructed to include a HIPPS codes on claims effective July 1, 2013, the edits for this requirement will not be turned on until sometime in September. CMS will get back to NAHC with a firm date as to when exactly. At least for the short term there will be no payment consequence for MA plans that do not submit a HIPPS code for home health services, and therefore home health claims should not be held up either.

CMS expects the HIPPS code to be entered on claims the same as with Fee for Service Medicare. We do urge the providers and their vendors to begin the necessary changes to their software systems to be ready for when the firm compliance date is announced. We also urge you to contact your health plans to determine what specifically they are, or are not, requiring related to including the HIPPS code on claims.

We are seeking feedback on whether agencies and vendors can alter their systems in time for September.

Home Health Line: Florida Association Seeks Congressional Relief From MA Pain

June 24, 2013

By Burt Schorr, Home Health Line

The visit authorization delays and denials home health agencies long have experienced in serving Medicare Advantage (MA) enrollees show no signs of going away. But a new letter from the Home Care Association of Florida (HCAF) to a key senator aims to provide relief for the ever-worsening situation.

Home health executives are finding themselves forced to invest more and more hours in getting the information and authorizations plans require. Indeed, plans’ coverage reductions and delayed authorizations effectively have restricted beneficiary access to quality home care, the HCAF noted in its recent letter to Sen. Bill Nelson, D-Fla., chairman of the Senate Aging Committee. (more…)

CMS is Requiring HIPPS Codes on Medicare Advantage Claims

June 19, 2013

Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage claims. The Centers for Medicare & Medicaid Services has instructed MA organizations to reject any home health claim that does not include a HIPPS code. According to a CMS communication with the health plans, CMS is requiring the HIPPS codes on home health claims in order to accurately price home health encounters. (more…)

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

June 12, 2013

By Gretchen JacobsonPatricia Neuman and Jennifer Huang, Kaiser Family Foundation

While much of the health policy world is focused on the health coverage developments in store as the Affordable Care Act of 2010 is implemented, private insurers are also gearing up for the next Medicare Advantage open enrollment season. Four months from now, just as exchange enrollment swings into action, Medicare beneficiaries will have the option to enroll in a Medicare Advantage plan (or switch plans) during the annual open enrollment period. And, earlier this month, each of the insurers participating in the Medicare Advantage program submitted what is known as a “bid” to the federal government that essentially indicates whether they will offer more or fewer Medicare Advantage plans in 2014 than in 2013 and how they will change their plans’ benefits and premiums, which could ultimately affect how many Medicare beneficiaries enroll in Medicare Advantage plans in 2014 and future years. (more…)

Medicare Advantage Plans Outperform Traditional Medicare

May 30, 2013

By , Fierce Healthcare

Medicare Advantage plans offered by private insurers result in better outcomes on certain key measures than traditional Medicare plans provided by the government, a new study shows.

Analyzing insurance claims for 3 million Medicare members, the Boston Consulting Group determined Medicare Advantage plans outperform traditional Medicare fee-for-service plans in single-year mortality, recovery from acute episodes of care requiring hospitalization and the sustainability of health over time, according to the study. (more…)

HCAF Calling for Input on Medicare Advantage & Home Health

April 1, 2013

HCAF representatives met recently with the U.S. Senate Special Committee on Aging staff, which is now chaired by Florida Senator Bill Nelson, to discuss issues impacting Medicare providers and beneficiaries. A major topic of discussion was Medicare Advantage and the concerns expressed my multiple providers related to authorization of care, specifically reduced and delayed authorizations. (more…)

Universal Health Care Stops Marketing New Policies

January 24, 2013

By Jeff Harrington, Tampa Bay Times

Financially struggling Universal Health Care, once among the fastest-growing companies in St. Petersburg, warned agents that it has stopped marketing its Medicare services in all areas effective immediately. The Tampa Tribune also reported this week that the company is being sold to a private equity firm.

The notice, which did not include a reason, could threaten the survival of the managed care company. Universal has already been losing members after being billed as a “consistent poor performer” by the federal government, which suggested in a letter to Medicare recipients in the fall that they consider shopping around for other options. (more…)