Key Insights for Home Health Providers from the 2024 Virtual National Provider Compliance Conference
Key Insights for Home Health Providers from the 2024 Virtual National Provider Compliance Conference
The Centers for Medicare & Medicaid Services (CMS) recently hosted the 2024 Virtual National Provider Compliance Conference (NPCC), a two-day event that brought together experts to provide essential guidance on Medicare fee-for-service (FFS) claims. Designed for provider staff and compliance professionals, the conference featured presentations from Medicare Administrative Contractors (MACs) and program integrity specialists. These sessions offered home health providers valuable tools and information to help ensure compliance in today’s complex regulatory environment.
For Medicare-certified home health providers, several sessions provided critical insights. Below is a summary of the key takeaways and specific data related to the home health sector.
Defining, Locating, and Using Medicare Coverage Policies
Understanding how to define and locate Medicare coverage policies was a central focus of this session. Providers were encouraged to regularly consult the Medicare Benefit Policy Manual and Local Coverage Determinations (LCDs) to ensure compliance and reduce claim denials. By keeping up to date with these policies, home health providers can safeguard against rejected claims.
Download the presentation slide deck here.
Maintaining Provider Enrollment Records
In this presentation, the importance of keeping CMS provider enrollment records up to date was emphasized. Home health providers were advised to regularly update their records in the Provider Enrollment, Chain, and Ownership System (PECOS) to prevent payment disruptions. This is particularly important when there are changes in ownership or contact information, as failure to update can result in compliance issues.
Download the presentation slide deck here.
Recovery Audit Contractor Program Update
The Recovery Audit Contractor (RAC) update provided an overview of the program, which aims to identify and correct improper Medicare payments. The presentation outlined the role of Region 5 RAC, which is dedicated to reviewing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and home health and hospice claims. Providers were advised to prepare for RAC reviews by maintaining comprehensive claim documentation and responding promptly to Additional Documentation Requests (ADRs). Notably, Region 5 RAC plays a pivotal role in ensuring compliance for home health claims.
Download the presentation slide deck here.
Targeted Probe and Educate Program Update
The Targeted Probe and Educate (TPE) program is an ongoing effort by CMS to reduce claim denials and ensure accurate payments to Medicare providers. In 2023, 1,033 home health agencies were reviewed under the TPE program. This program involves up to three rounds of review, with each round examining 20-40 claims per provider. Following each round, providers receive one-on-one education to address any errors. The goal is to correct issues early and prevent further denials.