Posts Tagged ‘outliers’

NAHC Working to Resolve Issues with Outlier Payments

May 15, 2013

The National Association for Home Care and Hospice made its first report to the Centers for Medicare & Medicaid Services (CMS) of errors in home health outlier calculations early in 2010. CMS acknowledged and began investigation of the problem, which was related to the newly imposed outlier cap calculation. CMS’ attempts to fix the problem in October 2011, and January, May and July 2012 were unsuccessful.

As a result, many home agencies did not receive full outlier payments for the years 2010, 2011 and 2012, with underpayments ranging from tens of thousands of dollars by small agencies to millions by large agencies. In its efforts to seek a solution to this problem, NAHC wrote to the CMS Acting Administrator on June 21 – and again after the failure of the July fix – requesting her assistance in an immediate resolution. In response, the Acting Administrator directed CMS staff to resolve the problem as quickly as possible and agencies across the country finally began to receive the money owed them beginning in August. (more…)

WEDNESDAY: CMS Home Health Open Door Forum

August 20, 2012

This month’s CMS Home Health, Hospice, & DME Open Door Forum is scheduled for Wednesday, August 22, 2012 at 2:00pm ET. Please call at least 15 minutes prior to the forum start time.

The agenda is as follows: (more…)

HCAF and NAHC Coordinating Efforts for Immediate Resolution of Outlier Underpayments

June 22, 2012

Since January 2010 an error in Medicare’s home health payment system related to outlier payments has created ever-increasing underpayments to providers who serve the sickest of home health patients. Outlier payments are additional payments made to the 60-day case-mix adjusted episode payments for beneficiaries who incur unusually large costs. These beneficiaries received additional services to meet needs greater than are identified through the case-mix system. In response to abuses of outlier payments, CMS imposed an agency aggregate outlier cap such that no more than 10 percent of an HHA’s total payments would be paid as outlier payments. (more…)