Proposed Changes to Exemptions for Minimum Wage and Overtime Pay

The U.S. Department of Labor (DOL) proposes to revise the current Fair Labor Standards Act (FLSA) regarding the exemption for companionship services and live-in domestic services.  The FLSA currently exempts from its minimum wage and overtime provisions domestic service employees employed "to provide companionship services for individuals who because of age or infirmity are unable to care for themselves."  The FLSA also currently exempts workers employed in domestic service in a household and who reside in such households from requirements to provide overtime pay.  More »

Part 6: Accountable Care Organizations (ACO’s) - Patients’ Right to Freedom of Choice of Providers

Patients who are assigned or "aligned" with physicians who participate in ACOs are not required to receive services from such physicians or from any other participants in ACOs. More »

Part 5: Accountable Care Organizations (ACO’s) - Can Post-Acute Providers Participate in ACOs?

ACOs seem to be the next "big thing."  Doctors and hospitals clearly have a role to play in ACOs.  Many post-acute providers, however; including home health agencies, hospices, and HME companies; would like to know if they can also be part of ACOs. More »

Part 4: Accountable Care Organizations (ACO’s) - Why Hospitals Need Post-Acute Providers

As indicated above, ACO's will share in cost savings if they meet performance standards for both quality of care and cost savings.  Specifically, there are thirty-three required quality measures for use in establishing performance standards that ACO's must meet in order to share in savings for at least the first year of three years.  More »

Part 3: Accountable Care Organizations (ACO’s) - Final Regulations Issued

Final regulations have now been released and will be published in the Federal Register soon.  The first agreements with ACO's will take effect on April 1, 2012.  The final regulations generally provide as follows: More »

Part 2: Accountable Care Organizations (ACO’s) - What Post-Acute Providers Should Do Now

Proposed regulations to implement these provisions were published in the Federal Register on April 7, 2011.  Comments regarding the proposed regulations must be received by the Centers for Medicare and Medicaid Services (CMS) no later than sixty days after the date of publication. More »

Part 1: Accountable Care Organizations (ACO’s) - Proposed Regulations

Section 302 of the Affordable Care Act (ACA) includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACO's).  Providers of services and suppliers who participate in ACO's will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings.  The Secretary of the U.S. Department of Health and Human Services is required to establish ACO's no later then January 1, 2012. More »

New OIG Advisory Opinion on Provision of Items and Services Below Cost or Free of Charge to Referral Sources in Exchange for Referrals

In an Advisory Opinion posted on August 4, 2011, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services concluded that the provision of items and services below cost or free of charge to referral sources likely violates the federal anti-kickback statute.  A home medical equipment (HME) company requested the Advisory Opinion. More »

Key Steps in a Home Health Agency Start up Process

In our previous article, we explored the important decisions one needs to make when entering the home health and hospice marketplace, whether to start-up a new agency or purchase one already in business. Perhaps, after looking at the home health or hospice agencies available in your community, you have decided to start your agency from scratch. Today, I explore the anatomy of an agency start-up, and the key steps involved in the start-up process. Finally, I offer tips you can use to ensure success in your new business venture. More »

To Purchase or Start-Up a New Home Health Agency: How Do You Decide?

Are you new to the home health and hospice marketplace? With the aging demographics of the American population, there is increased interest in home health and hospice agencies as viable business opportunities. If you have made the decision to enter the home health or hospice marketplace, the next, most important decision to make is whether to start up your agency or purchase one already in business. There are advantages and disadvantages to either choice. Today, I provide some guidelines to help you make a decision that is right for you. More »

Post-Acute Providers That Pay to Participate in Discharge Planning Systems Likely Violate the Anti-Kickback Statute

On May 20, 2011, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion 11-06.  This Opinion makes it clear that post-acute providers that pay hospitals to participate in e-discharge planning systems likely violate the federal anti-kickback statute.  Hospitals utilizing such systems that require post-acute providers to "pay to play" also likely violate the federal anti-kickback statute. More »

Home Health Agencies Cannot Provide Services When Face-to-Face Requirements are Not Met

Section 6407 of the Affordable Care Act (ACA) requires a face-to-face encounter between patients and their physicians for certification of eligibility for Medicare home health services.  Certifying physicians must document that they or non-physician practitioners working with physicians have seen patients. The encounter must occur within 90 days prior to the start of home care services or within 30 days after the start of home care. More »

Face-to-Face Encounters by Medical Directors

Effective April 1, 2011, providers may not be paid for services rendered if patients have not had appropriate face-to-face encounters with physicians during required time periods. In order for home health agencies and hospices to be paid for services provided, documentation of these encounters must also meet applicable requirements. More »

Face-to-Face Encounters: Avoiding Liability for Abandonment

Providers are at risk for legal liability when they terminate services to patients. Termination of services has historically been warranted by the following circumstances, among others: violence or threatened violence, noncompliance by patients and/or primary caregivers, inability to provide adequate assistance, or inappropriateness for services. Providers are understandably concerned about the possibility of legal liability associated with the termination of beneficial services. More »

PART 1: Revised Standards of Practice for Case Management – Duty to Advocate

Standards governing the practice of case management were first published in 1995 by the Case Management Society of America (CMSA). The standards were revised for the first time in 2002, and again in 2010. This is the first in a series of articles about the legal and ethical implications of the standards revised this year. More »

PART 2: Revised Standards of Practice for Case Management – Ethics and Patients’ Right to Freedom of Choice of Providers

Standards governing the practice of case management were first published in 1995 by the Case Management Society of America (CMSA). The standards were revised for the first time in 2002 and again in 2010. This is the second in a series of articles about the legal and ethical implications of the standards revised this year. More »

Do Your Homework!
Due Diligence 101: Home Care and Hospice

The activities during the due diligence of a home health or hospice license – whether covering single or multiple locations – involves the examination of a number of components in order to assess the efficiency and compliance of an agency. We use a number of proprietary forms to guide the audits in areas such as clinical, regulatory, administrative and environmental considerations. Within each area are key indicators that the auditors use to measure the findings against industry requirements or best practice. Our forms are industry-specific and reflect both the federal requirements and state regulations. More »

Part 1: Preparing for Audits - ZPIC Audits

The Centers for Medicare and Medicaid Services (CMS) are now conducting ZPIC audits. ZPIC’s are conducted by Zone Program Integrity Contractors. Unlike RAC audits that target identification of overpayment and CERT audits that attempt to pinpoint improper payments, ZPIC audits focus on fraud in the Medicare Program. This means that ZPIC contractors can audit the integrity of all Medicare claims, both pre- and post-payment. More »

Office of Inspector General (OIG) Provides Additional Guidance About Incentive Compensation

The OIG recently provided additional guidance regarding incentive compensation for referrals in an Advisory Opinion. Specifically, a continuing care retirement community (CCRC) provided incentive compensation to its employees. More »

The Cookie Lady is Dead!

For the past 22 years I’ve weathered Nor’easters in New England, Tropical storms in the Southeast, whiteouts in the Midwest, heat waves in the South and even earthquakes in the West. No, I’m not a meteorologist. I’m a sales coach and trainer specializing in hospice and homecare. I’ve experienced Mother Nature’s wrath obtaining various “goodies” while riding with sales reps so they can hand them out to their referral sources! More »

Why Discharge Planners/Case Managers Need to Know About Legal Implications of Provision of Free Services to Patients

Based upon their overriding commitment to patients, case managers or discharge planners may be tempted to “take up the slack” by urging post-acute providers to render free or voluntary services to patients. Case managers/discharge planners may state to post-acute providers that they will not receive additional referrals unless they agree to provide services to so-called “indigent patients,“ some of whom may not have a payor source for their care. More »

Health Care Reform - Physicians and Patients’ Right to Freedom of Choice of Providers

To date, only hospitals are required to present lists of some types of providers to patients so that they can choose which providers they want to render services to them. Likewise, statutes in some, but not all states, require physicians and other types of providers to give notice to patients if they have financial/ownership interests in providers to which they make referrals. As a result of health care reform, the “picture,” with regard to physicians and patients’ right to freedom of choice, is about to change. More »

Are Potential Kickback Issues Resolved by Payment of Fees to Third Parties Instead of Hospitals to Get on “Vendor Lists” or to Participate in “e-Discharge” Systems?

Payments by post-acute providers to be placed on “vendor lists” or to participate in “edischarge” systems may constitute prohibited kickbacks in violation of the federal antikickback statute. First, payments to be placed on vendor lists in order to get referrals are inappropriate because post-acute providers are not vendors. More »

Patients’ Right to Freedom of Choice of Hospices in Hospitals

All providers are required to abide by patients’ right to freedom of choice. There are a number of sources of this right as follows: 1) All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. More »

The Challenge of Maintaining Margin in Home Health Care

The most important business metric to monitor on a frequent, ongoing basis is gross margin. With the general emphasis on revenue growth and profit, often the importance of gross margin gets lost. More »

Use of Preferred Provider Agreements by Discharge Planners/Case Managers

Many hospitals refer patients on a regular basis to post-acute providers; such as home health agencies, private duty home care agencies, hospices, and home medical equipment (HME) companies. Relationships with post-acute providers assist hospitals with controlling their length of stay (LOS), an essential component of financial viability. Consequently, positive relationships with post-acute providers are essential to the success of discharge planners/case managers. More »

Standards of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Unlikely to Support Practices of Hospitals That Treat Post-Acute Providers as “Vendors”

Post-acute providers continue to be “plagued” by hospitals that claim that post-acute providers cannot enter hospitals and/or gain access to patients to coordinate post-acute services because they are “vendors.” Some hospitals claim that access by "vendors" is prohibited by JCAHO standards. Other hospitals may permit access by post-acute providers only if they comply with complex, inapplicable restrictions that hospitals claim are based on JCAHO standards. More »

Discharge Planners/Case Managers Must Make Neutral Presentations of Patients’ Right to Freedom of Choice of Providers

All patients have the right to freedom of choice of providers. Discharge planners/case managers have legal and ethical obligations to honor this right.

There are a number of sources of this right as follows:
1) All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. More »

Part 1: Home Healthcare Accreditation from ACHC

Now that agencies have to turn to other sources than their States for accreditation, let’s take a look at one of the newer options: Accreditation Commission for Health Care, Inc. (ACHC). Although ACHC seems to be in its infancy compared to some other accrediting bodies, it has actually been in existence since 1986. More »

Part 2: Home Healthcare Accreditation from ACHC

Last month, we covered the questions: How long does it take to become accredited? How much does it cost? So let's take a look at some of the specifics of ACHC processes and some suggestions they make. I call it the ACHC Top 10 List. More »

About Home Telehealth: Inroads Made to Date in Service Delivery

Home telehealthcare is one of the most rapidly developing service frontiers in healthcare delivery today. Among its most sought after features: a range of telemonitoring devices and services helping to keep patients relatively well and reducing use of costly emergent and acute care services. By regularly tracking co-morbid patients at home, telehealth systems can signal nurses for scheduling timely, targeted interventions to patients, as needed. More »

Where Have All The Miles Gone?

There are many ways to come at the challenge of improving the bottom line. While growing the business certainly brings the most kudos from corporate management, boards and investors, trimming costs without sacrificing quality can often be quicker and more predictable. More »

Deliver Best What Your Customers Want Most

If you are like most agency owners/administrators in Home Health, Private Duty and Hospice, you are surrounded by competitors. You are constantly thinking about how to gain market share. You want to differentiate your agency from your competitors so that current AND new customers will be turning to you more frequently. More »

Home Health Agency Accounts Receivable Management: Policy/Procedure and Work Flows

Home health managers face billing and collections challenges every day. Minimizing these challenges and improving cash flow is, or at least should be, at the top of every manager's list. Developing and documenting the framework by which the agency will manage accounts receivable is one of the most effective ways to improve cash flow. More »

How the Nursing Staph Let Me Down

You cannot pick up a paper or turn on the television news lately without finding something about methicillin-resistant Staphylococcus aureus (MRSA), the “super bug”. Consumer advocates state and early evidence suggest that this super bug kills more Americans than AIDS. Recent studies found that over 90,000 Americans each year are infected by MRSA. More »