According to my sources, during the CMS open door teleconference this afternoon, CMS announced the HHABN implementation deadline would be extended. Although no official new date was provided, apparently the extension will be until at least September 1, 2006. CMS also indicated new instructions would be forthcoming as well as a new Q&A within the next ten days. I am sure everyone is breathing a sigh of relief over this decision. Hoepfully, the new instructions and Q&A will be clearer.
I will post more as this develops.
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I have been a little sporadic in my posts the last week. That was in part due to speaking at the Indiana Association for Home and Hospice Care?s annual conference. I spoke on Tuesday and Thursday, which made Wednesday and Friday rather hectic at the office.
As promised two weeks ago, I read the Medicare final rule on Establishing and maintaining Medicare Billing Privileges. It was published on April 21, 2006. It is effective June 20, 2006.
The rule covers enrolling as a provider, denial of enrollment, and revocation of enrollment. In most respects, the rule reflects how enrollment has been handled by manual and memo for years. The rule does add a requirement for the resubmission and recertification of enrollment information.
The rule requires providers to resubmit and recertify the accuracy of their enrollment information every five years in order to maintain their Medicare billing privileges. The rule states that all providers who are currently billing the Medicare program are required to complete the applicable enrollment application. Providers will then be placed into the five year revalidation cycle. In the comments, CMS states that they will contact currently enrolled providers to let them know when their revalidation cycle starts.
The rule states that CMS will contact each provider when it is time to recertify. The provider will then have sixty days to respond to the request. Of course, although the rule requires resubmission every five years, CMS specifically reserves the right to perform ?off-cycle? resubmissions
According to the rule, off-cycle resubmissions may be triggered by a number of factors. These factors include complaints, national initiatives and suspicions of local health fraud, amongst other things.
The rule states that you will not have to have an additional survey as part of the ?resubmission.? You will also not have to complete a new provider agreement. CMS may perform an ?on-site inspection? to confirm your submission. This may sound like a survey, but it strikes me that adding another survey (especially for those of you who are surveyed annually for licensure and certification) would be burdensome for CMS, states, and providers.
CMS states in the comments that the resubmission is necessary for a number of reasons. Primarily, CMS is hoping that this resubmission will help them identify entities that are billing Medicare inappropriately. In the comments to the final rule, CMS states that the revalidation process will ?further ensure that Medicare beneficiaries are receiving services furnished only by legitimate providers.? Its funny, I figured the annual survey accomplished that just fine. Anyways, you should be awaiting notification from CMS that your five year period had begun. I assume that when you receive this notification you will have sixty days to respond with the appropriate enrollment information.
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Late last week, CMS issued a new frequently asked questions on the new HHABN. The questions shed light on a number of issues as well as change the rules on when you issue an HHABN.
The biggest impact of the F.A.Q. is in the area of non-covered care. The original instructions indicated that upon an initiation, termination, or reduction of non-covered care, the beneficiary should receive an HHABN. In responding to questions on the potential for confusion created by issuing an HHABN for non-covered care, HHS revised its instructions.
According to the new F.A.Q., if care is not covered by Medicare, meaning it is paid for by another payor source and Medicare is not the secondary payor, you only issue an HHABN upon initiation of care. Let me repeat that, for care that is not covered by Medicare, you only issue an HHABN upon initiation of care. You do not need to issue an HHABN for reductions or terminations. That should alleviate some of the burden associated with HHABNs.
Of course, if Medicare coverage becomes an issue later, you will need to issue an HHABN.
Another interesting point from the F.A.Q. has to do with reductions in care after a recertification. You may recall that the original instructions stated if the plan of care calls for a reduction in services, you do not need to issue an HHABN for the reductions that occur as set forth in the original plan of care. CMS has clarified that if after recertification the plan of care calls for reductions, you have two options. You may issue an HHABN with the new plan of care and then you need not issue an HHABN for the reductions that occur as set forth in the HHABN. Your other option would be to not issue the HHABN upon recertification, but to issue an HHABN with each reduction that occurs under the plan of care.
Finally, the F.A.Q. reiterates that if you are reducing services because you do not have a physicians order for the services any longer, you should use option box 1 to explain the reduction. CMS indicated they understand the potential for confusion, but they felt it more appropriate to use option box 1, even though the beneficiary cannot actually pay you to continue providing the service if the doctor refuses to order it.
Although the rationale may not make a lot of sense, CMS has clearly stated which option box to use.
Of course, with only a few weeks to go until the June 1 deadline for the new HHABN, you should expect further clarification as well as new forms from CMS.
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For those of you who have been busy trying to figure out the new HHABN form and rules, HHS issued a new set of frequently asked questions late last week. The questions clarify a number of issues relating to when an HHA needs to issue an HHABN. They may also change some of the situations that require an HHABN. You can download them from CMS’s website or you can click on the link at the end of this post to download a copy.
I have not had a chance to read through the entire list of questions, but I promise to post a summary of key points later today. (Today is one of those days when the practice of law gets in the way of blogging. I have a few appointments this morning that will prevent me from reading the FAQ until after lunch.)
Attachments:
04_20_2006HHABNFAQ.doc
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