It is hard to believe that January 2019 is already in the books. So much is changing fast in the home care and hospice industries. Several years ago Civil Monetary Penalty laws were revised to allow surveyors latitude to impose CMP’s on agencies during a survey. CMS suspended this action through January 13, 2019 but took no action in January to extend the suspension. We are hearing from clients and others in the industry that survey deficiencies are on the rise, especially in regard to measuring compliance with the new home health CoP’s. In addition, the OIG highlighted in its hospice work plan for this year that a focus will be investigating harm to patients. Heretofore, responding to survey deficiencies has required expenditure of administrative resources to develop and implement plans of corrections. Now with the CMP laws in place and criteria established to allow surveyors to impose money penalties, agencies may also face serious financial implications.
In another surprise move, the Moratorium on new home health agencies that has been in place in specific cities or states sunset on January 31, 2019. For several years the moratorium has been extended for six months periods, but not this time. CMS alluded to the fact that they now have other sufficient monitoring tools in place to combat fraud, waste and abuse. The non-action to extend the moratorium follows soon behind CMS’ announcing that Cert Testing yielded a significant decline in home health billing error rate (17.6% in 2018 compared to 32% in 2017). We also know that the Targeted Probe and Educate (TPE) program is now the new normal for MAC Contractor medical review process and Review Choice Demonstration (RCD) is still looming though delayed for OMB final approval of the demonstration project.
We will continue to admonish providers toward implementation of bona-fide compliance programs. To-date our participation is classified as voluntary by the Office of Inspector General and we have suggested guidelines to follow. We find still that many agencies operate on a wing and a prayer in regards to compliance. Regulatory Compliance, LLC d/b/a SMART Healthcare Resources and SMART Healthcare Compliance Resources, LLC are dedicated to assisting our clients in their Compliance endeavors.