I have been meaning to comment on the proposed ?resurvey fee? that was reported in Home health line a few weeks ago, but have been so busy, I got very delayed. Home health line recently reported a proposal from CMS to require hhas to pay a $1600 ?resurvey? fee if they require a revisit to demonstrate compliance after a survey. The proposal would even require a fee if the state agency only did a paper review at its offices.
Of course, CMS thinks this is a great idea, as it has the potential to generate millions of dollars in revenue for CMS, but there are a number of problems that it creates. First, once CMS starts charging a fee for federal resurveys, you can expect states to start doing it as well. Although you usually have a state and federal survey simultaneously, I can?t help but think that a state agency would start charging agencies a similar fee. I know in Indiana, the state has a hard time getting all of the sureys done, in part due to budgetary limitations, and a resurvey fee is one way to help fix this problem. Whether a state licensed and Medicare certified agency would need to pay two fees would be a separate question, but it is not beyond belief that you would get charged two resurvey fees. (Of course, this would seem like a windfall, since the state performs both surveys simultaneously.)
Worse than these issues, however, is the fact that such a fee further punishes agencies for a survey report that, even if it is obviously factually wrong, they have no ability to challenge. Charging this fee assumes the survey process is an objective one and that the findings are correct. Unfortunately this is not the case. A surveyor?s findings are the result of the surveyors interpretation of the evidence and judgment calls on the application of the regulations.
For example, many agencies have been cited by a surveyor for doing something one way, changed it to conform with what they surveyor demanded and then been cited again on their next survey for doing exactly what the last surveyor told them to do. Why should an agency have to pay a fee to be resurveyed in those circumstances? Another example is the mistaken surveyor. I have seen surveyors get their facts completely wrong and when later presented with clear evidence of their error, they still refuse to revise the finding. At this point, because the courts have decided that a survey report is not an order (even though it finds facts, determines liability and requires a response), you have no option but to submit a plan of correction and, if implemented, pay the fee.
In essence, you are being fined, but by calling it a resurvey fee, they are hoping to avoid providing you with any due process first. (It would be interesting to see if a court would view this ?fee? differently.) If you fail to pay the fee, you are then at risk for losing your Medicare billing privileges. This is just one more way to make a fundamentally unfair and subjective process even more unfair. The vast majority of agencies are cited for some violations every time they are surveyed. If you have to pay for a resurvey, you are looking at $1600 a year as an additional operating expense. (Combined with the potential revenue reductions courtesy of the revised PPS.) If an agency required more than one resurvey before they were found to be in compliance (which can happen), the agency could spend more than three thousand dollars on resurvey fees, not to mention on legal fees, consultant fees, etc.
If the government feels they are losing money due to resurveys, they should focus on the survey process, training surveyors and eliminating as much of the subjectivity as possible in an effort to reduce the need for resurveys. They could also look at ways to reduce the number of surveys. Indiana, for example, will not accept certain accreditations in lieu of an annual survey. (Yes, I know JCAHO costs money, but I have been told their survey process is not as onerous as CMS.) Agencies should not be punished for requiring a resurvey when they have not procedure to challenged erroneous findings in the survey.
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HHS has announced a new demonstration project to combat home health fraud. This demonstration project will begin in Los Angeles and Houston. HHS?s goal is to prevent fraudulent home health agencies from entering into the Medicare billing system. The project was announced as a response to a number of Medicare billing issues in the target cities.
Medicare has noticed that billings in these two areas have increased by as much as sixty percent and the number of providers has increased by 150%. This has apparently cased HHS to become concerned that there are unlawful agencies entering the market and billing Medicare. The announcement does not specifically state what type of fraud they are targeting, but it implies that certain home health agencies are preying upon the elderly.
It appears that the agencies are using the elderly patients Medicare numbers to bill for services that are not provided or to perform some other fraud and HHS believes this fraud is related to an increase in the number of ?illegal? home health agencies. As you can see from the project, they are especially concerned about ownership and strict compliance with Medicare requirements.
In order to combat this problem, the demonstration project will introduce a number of measures aimed at identifying illegal home health agencies and excluding them from the Medicare program. HHS?s first step is to have agencies in the Los Angeles and Houston areas resubmit their provider applications. The announcement does not make it clear if all agencies will have to reapply, but does state that agencies will receive a notice to reapply. Agencies who receive the notice but do not reapply within sixty days of receiving the notice will have their Medicare billing privileges suspended.
Providers who have failed or in the future fail to report a change of ownership or change of address will have their billing privileges revoked. Any provider whom HHS determines has an owner, partner, director, or managing employee with a felony conviction in the last ten years will have their billing privileges revoked. Any provider that no longer meets each and every one of the provider enrollment requirements will have their billing privileges revoked. Finally, any HHA that underwent a change of ownership in the last two years will be required to undergo a state survey.
While the project is initially slated in only two areas, I cannot help but focus on the phrase ?demonstration project?. Often, today?s demonstration projects are tomorrow?s regulatory practices. This practice would create a great deal of additional burden on any provider who received a notice. It will be interesting to see how they determine who has to reapply.
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