Politics & policy

Insight into federal and state health care legislation & CMS regulation

What's New Is Old For Home-Health Agencies in U.S.

Attention home-health agencies: In a major policy shift, the Health Care Financing Administration no longer will treat as "new" any agency that otherwise would qualify as "old" if not for the fact that it changed its organizational status from freestanding to hospital-based (or vice-versa) after fiscal 1994.

As a result, revisions to the per-visit and per-beneficiary payment limits governing the home-health interim payment system take effect this month — a move that should help those formerly "new" (how's that for an oxymoron?) agencies whose per-beneficiary reimbursement had been limited to the lower national average, rather than the higher blended-payment formula (75-percent agency specific, 25-percent regional).

Meanwhile, home-health agencies have received a hint from HCFA to check the legal health of their own homes: They have received a compliance guide to help them detect and combat Medicare and Medicaid fraud and abuse. The key point in the 62-page opus is that those who develop compliance plans should take a hard look for billing problems, falsified records, kickbacks for referrals, hiring individuals with criminal records and failing to refund overpayments.

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