Compliance Monitor (11/27/2024)

Thursday, December 12, 2024 

Register for this virtual conference. 

CMS will convene change makers from the healthcare community and federal government to share new ideas, lessons learned, and best practices to reduce administrative burden and strengthen access to quality care. 

You can explore the full schedule to see the sessions and topics that will be discussed at cmsburdenreductionconference.com. 

CMS posted the “Ensuring Consistency in the Hospice Survey Process to Identify Quality of Care Concerns and Potential Fraud Referrals” memo (QSO-25-06-Hospice) to CMS States and Regions on 11/14/2024 to reinforce that all elements of the survey process be consistently performed to safeguard hospice patients and ensure the integrity of Medicare funding for hospice care. 

This memorandum is intended to reinforce existing tools to identify when a hospice provider’s non-compliance with the CoPs puts the health and well-being of patients at risk and could be an indicator of the need for a fraud referral. 

While this memo focuses on federal survey processes and enforcement, we also seek to highlight independent state licensure authority that may similarly stop and/or mitigate the impact of potential fraudulent practices on patient health and safety. Some states have implemented licensure processes for hospice providers to protect state programs and patients from fraudulent or abusive behavior. 

All hospice providers are strongly encouraged to review this memo. 

The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Thursday, December 12^th, from 1:00 – 2:00 P.M. ET to share an Introduction to Hospice Outcomes and Patient Evaluation (HOPE). 

Subject matter experts will also answer questions at the end of the webinar, as time permits.  

Webinar Details 

• Title: HQRP Forum 

• Date: Thursday, December 12, 2024 

• Time: 1:00 – 2:00 P.M. ET 

To register, please visit this link: https://abtassociates.webex.com/weblink/register/r9225e1dc9fa589fc2f5b2d433841aba0. 

Hospice Updates 

The November 2024 quarterly refresh for the Hospice Quality Reporting Program is now available on Care Compare. 

For additional information, please see the FY2025 Hospice Wage Index Final Rule at https://www.cms.gov/Center/Provider-Type/Hospice-Center. Please visit the Hospice Background and Announcements webpage to review the Claims-Based Measures Questions and Answers downloadable (PDF) for more information on the HCI and HVLDL. 

The registration webpage has been updated.  

Registration 

Learn about updated payment rates (PDF) effective January 1, 2025: 

• 30-day periods of care payments 

• National per-visit amounts 

• Disposable negative pressure wound devices 

• Cost-per-unit amounts used for calculating outlier payments 

The Preliminary October 2024 Interim Performance Reports (IPRs) for the expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data for the 12 most recent months, and the interim Total Performance Score (TPS). Using the IPR, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year. The October 2024 IPRs also report preliminary Achievement Thresholds (AT) and Benchmarks (BM) by volume-based cohort for the quality measure set applicable to the third performance year, CY 2025, and following performance years, respectively. 

  An HHA will receive an October 2024 IPR if the HHA: 

• Was Medicare certified prior to January 1, 2023, and 

• Meets the minimum threshold of data for at least one (1) quality measure in the quarterly reporting period for the performance year shown in Exhibit 1.  

 Exhibit 1: October 2024 IPR quality measure performance scores time periods for each measure category 

Effective January 1, 2025, CMS will reduce the timeframe for Medicare Administrative Contractors to review Medicare Fee-for-Service standard prior authorization requests to no more than 7 calendar days. 

More Information: 

• Prior Authorization Process for Certain DMEPOS Items 

Learn about the advantages of participating in Medicare and changes for CY 2025. Your Medicare Administrative Contractor sent you a postcard with a link to the announcement (PDF). 

See Annual Medicare Participation Announcement for more information. 

Improper payments are payments that do not meet CMS program requirements. They can be overpayments, underpayments, or payments where insufficient information was provided to determine whether a payment was proper. Most improper payments involve a state, contractor, or provider missing an administrative step. CMS is committed to ensuring the programmatic and fiscal integrity of its programs. 

Review the Fact Sheet 

People living in rural areas, Tribal nations, territories, and other geographically isolated areas face unique health care challenges (see Rural Health). On National Rural Health Day, get the latest news on rural health programs and policy so you can better address your patients’ health care needs. 

More Information: 

• CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities (PDF) overview 

• CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities (PDF) report 

• Rural Health Clinics Center webpage 

In 2023, the improper payment rate for Enteral Nutrition was 28.7%, with a projected improper payment amount of $43.2 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices D, E, G, and K). Learn how to bill correctly for these services. Review the Enteral Nutrition provider compliance tip for more information, including: 

• Billing codes 

• Denial reasons 

• Refill and documentation requirements  

The Office for Civil Rights Should Enhance Its HIPAA Audit Program to Enforce HIPAA Requirements and Improve the Protection of Electronic Protected Health Information (A-18-21-08014) 
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a new audit in review of the Department of Health and Human Service’s Office for Civil Rights’ (OCR) HIPAA audit program at securing electronic protected health information (ePHI). The audit found OCR‘s oversight of the program was not effective at improving auditee cybersecurity protection—too narrowly assessing security criteria and failing to implement physical and technical safeguards for data, such as encryption access controls and ransomware protections. HHS-OIG’s recommendations for OCR include insight on the expanding the scope of its HIPAA audit and guidance for resolving deficiencies in compliance. Amid heightened data breaches, this report further underscores critical need for the effective enforcement of HIPAA. 
Read the Full Report 

Wednesday, December 4, 2024, at noon ET 

Register for this webinar. 

Join the Office of Climate Change and Health Equity and the Environmental Protection Agency’s Office of Environmental Justice and External Civil Rights to learn about the Environmental Justice Thriving Communities Grantmakers Program. The program offers subgrants for capacity building in communities affected by environmental or public health issues to eligible applicants, including nonprofit organizations. Topics include: 

• Air quality and asthma 

• Improving food access to reduce vehicle miles traveled 

• Emergency preparedness and disaster resiliency 

• Environmental job training for occupations that reduce greenhouse gases and other air pollutants