New Enrollment, Revalidation Fees Hit Home Care Providers

By Author: Eli Healthcare
Total Articles: 7
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Also: Your chances of screening scrutiny increase this month.
Starting March 25, you’ll have to pay a pretty penny to enroll or reenroll in Medicare — $505. “CMS and its contractors will not be able to process any applications without the proper application fee having been paid and credited to the United States Treasury,” CMS says in an e-mail to providers. “If the fee is not submitted, the application will be rejected or billing privileges revoked.”
As required in the Affordable Care Act, CMS will charge the enrollment/revalidation fee to non-physician providers, including home health agencies, hospices, and durable medical equipment suppliers.
Exception: If you truly can’t afford the fee, CMS may give you a break. Contractors “will accept hardship exception requests from institutional providers,” the agency says. “However, determinations on whether to grant these requests will be made on a case-by-case basis.” If CMS turns down a hardship request, the provider will have 30 days to pay the fee.
The new fee is just one change to the enrollment/ ...
... revalidation process. Starting on the same date, CMS will place enrolling or revalidating providers into new screening categories based on their provider type.
As finalized in a Feb. 2 Federal Register rule, CMS is establishing a three-tier category ofrisk for screening levels — low, moderate, and high.
Existing HHAs and DME suppliers, plus all hospices, fall into the moderate risk category. They’ll be subject to unscheduled or unannounced site visits on top of the basic requirements, which include verification of Medicare requirements, license verifications, and checks of databases such as the OIG exclusions database.
Newly enrolling HHAs and DME suppliers will fall into the high risk category, which will have to undergo criminal background checks and fingerprinting.
If you’re submitting claims for five-visit episodes with a single nurse or social worker visit, you’re at high risk of denials.
Regional home health intermediary Cahaba GBA is continuing to run widespread edits on these two types of claims, it says in its March newsletter for providers. And both types of claims are turning up high denials rates — 83 percent for the claims with one nurse and four therapy visits, 75 percent for the claims with one medical social worker and four other visits.
For the single nurse visit edit, “the top denial reason … was related to medical necessity of the one-time skilled nurse visit,” Cahaba explains. If the nurse opens the case and performs the start of care assessment, that visit is not billable — unless the nurse also delivers a medically necessary skilled nursing service.
Tip: “If the skilled need for the nurse is observation and assessment, there is greater need than a one-time visit,” Cahaba says. And don’t forget that the therapist can perform a SOC assessment.
For the single MSW visit, “many of these denials are related to the medical necessity of nursing and/or the MSW visit,” Cahaba reports. “Routine evaluations for community resources where no needs were previously identified would not be considered a covered MSW service.