Hospice and Home Health Agency (“HHA”) Providers Subject to RAC Audits
Hospices and home health agency (“HHA”) providers were excluded from Recovery Audit Contractor (“RAC”) auditing activity during the RAC demonstration program, which ended in 2008. However, in the nationwide RAC permanent program, RACs are authorized to conduct audits of hospices and home health providers.
Hospice
Hospice providers should begin to prepare for increased Medicare scrutiny. Areas of compliance risk for hospice providers include the following:
- Patients with certain diagnoses prone to longer hospice stays (e.g., patients with Alzheimer’s disease, Parkinson’s disease, chronic obstructive pulmonary disease (“COPD”), heart disease, etc.).
- Technical reasons for Medicare denials (e.g., hospice election statements, certifications, plans of care, etc.).
Our firm has extensive experience representing hospice organizations with respect to Medicare audits and pre-payment review. For example:
- Our firm represented a hospice entity, which had been subject to an audit of its services provided to 17 beneficiaries. In that case, we received 14 favorable decisions on the record, without even the need for a hearing.
- Our firm currently represents a hospice entity that was subject to pre-payment review. To date, our law firm has returned over $4 million to the entity, with a high success rate. As a result of these successes, the hospice was removed from pre-payment review.
Home Health Agency (“HHA”) Providers
Significantly for HHAs, the Centers for Medicare and Medicaid Services (“CMS”) recently has announced its intention to focus auditing activities upon HHAs and durable medical equipment (“DME”) suppliers. Areas of compliance risk for HHAs include the following:
- Whether the Home Health Resource Group (“HHRG”) assigned to determine payment to the HHA is accurate and supported by documentation in the records.
- Whether the services provided were medically necessary.
- Certification deficiencies.
At Wachler & Associates, P.C., we have been providing strong and knowledgeable legal counsel and advocacy to hospices, HHAs and other healthcare providers, suppliers and entities for over 20 years.
Pre-Payment Review Representation
Hospices and HHAs can be targets for medical review for many reasons. New hospices and HHAs may be placed on pre-payment review. In addition, if your hospice or HHA experiences a sudden or significant increase in utilization, your agency may be placed on pre-payment review.
Although the RACs are not authorized to initiate pre-payment review, Medicare intermediaries are authorized to initiate pre-payment review, which can interrupt cash flow and result in a significant financial burden.
Our attorneys have experience negotiating successfully on behalf of hospices and HHAs to assist these agencies in being removed from pre-payment review.
Publications and Speaking Engagements
Attorneys from our law firm are often asked to write and speak to hospice and home health organizations. Recent writing and speaking engagements include the following:
Publications
"The RACs are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., Member Briefing: American Health Lawyers Association Hospitals and Health Systems Practice Group, January 2009.
"RAC to the Future: What Can Medicare Providers and Suppliers Expect from the Recovery Audit Contractor Program?" co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, Vol. 21, No. 2, December, 2008.
"The RACs Are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., The RAP Sheet, American Health Lawyers Association, Regulation, Accreditation and Payment Practice Group, December 2008.
"Recovery Audit Contractors and Medicare Audits: Successful Strategies for Preparing for and Defending Audits," co-author Andrew B. Wachler, Esq., Journal of Health Care Compliance, September-October, 2008.
"Recovery Audit Contractors and Medicare Audits: Successful Strategies for Defending Audits," co-author Andrew B. Wachler, Esq., Caring, National Association of Home Care and Hospice, November, 2008.
"The Medicare Appeals Process and Strategies for Successful Appeals," co-author Andrew B. Wachler, Esq., American Health Lawyers Association, Physician Organizations, Vol. 10, Issue 1, Winter, 2007.
"Get Ready: The RACs May Be Nationwide Sooner Than Expected!" co-author Andrew B. Wachler, Esq., HCCA Compliance Today, 2007.
"The New Medicare Part A and Part B Appeals Process," co-author Andrew B. Wachler, Esq., Health Law Handbook 2006, Part I, Chapter I, 2006.
"The New Medicare Appeals Process," co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, June 2005.
Speaking Engagements
"Current Legal Issues for Hospices," National Hospice Work Group, October 23, 2009.
"RACs & Medicare Audits: Compliance Tips and Successful Appeals Strategy," Annual Meeting of the National Association of Home Care & Hospice (NAHC), October 10, 2009 - October 14, 2009.
"Latest Developments Related to the Nationwide Expansion of the Recovery Audit Contractors," Michigan Bar Association, Health Law Section, September 24, 2009.
"Recovery Audit Contractors: An Overview of Current Legal and Appeal Strategies," American Society of Medical Association Counsel (ASMAC), September 18, 2009.
"RACs & Medicare Audits: Compliance Tips and Successful Appeals Strategy," Indiana Association for Home & Hospice Care, May 19, 2009 - May 21, 2009.
"RACs: Appeals Strategies," Health Business Management Association (HBMA) 2009 Spring Education Conference, May 6, 2009 - May 8, 2009.
" RAC Audit Appeals- Strategies and Defenses for Overturning Hospital RAC Denials," National Healthcare Compliance Audioconference, May 5, 2009.
"Ready or Not, Here They Come! Preparing for and Defending the RACS," (HCCA) 13th Annual Compliance Institute, April 26, 2009 - April 29, 2009.
"Advanced Appeals Workshop," 2009 American Health Lawyers Association (AHLA) Institute on Medicare and Medicaid Payment Issues, March 25, 2009 - March 27, 2009.
"The Basics: How the RAC Appeals Process Works," National Medicare RAC Summit, March 5, 2009 - March 6, 2009.
"Recovery Audit Contractors and Medicare Audits," 2009 American Bar Association (ABA) Emerging Issues Conference, February 18, 2009 - February 20, 2009.
"Recovery Audit Contractors & Medicare Audits," National Hospice & Palliative Care Organization (NHPCO), October 24, 2008.
"Recovery Audit Contractors & Medicare Audits: Successful Appeals Strategies and Compliance Tips," 2008 Annual Meeting of the National Association of Home Care & Hospice (NAHC), October 11, 2008 - October 15, 2008.
"The Medicare Appeals Process and Strategies for Successful Appeals," Michigan Home Health Association (MHHA), May 14, 2008.
"The Medicare Appeals Process," 2007 Annual Meeting of the Michigan Hospice and Palliative Care Organization (MHPCO), 2007.
"The New Medicare Appeals Process and Strategies for Successful Appeals," Michigan Hospice and Palliative Care Organization (MHPCO), May 2006.
For a more complete listing of our publications and speaking engagements, please click here..
Contact Us
Call us at 248-544-0888 or send us an e-mail to schedule a meeting to discuss your concerns with RACs or to address your other healthcare law-related needs.
