Miami Home Healthcare Accountants Bad Debt Recovery
Miami Home Healthcare Accountants Gustavo A Viera CPA we’re concerned as the economic recession continues and with the rise in unemployment, Home Healthcare Accountants must deal with accelerated growth in bad debts in addition to the myriad of other financial and operating challenges presented during the downturn. Home Health Agency Accountants understand that while all bad debts cannot be recovered, 70% of allowable Medicare bad debt claims, including Medicaid cross-over balances, can be salvaged through the filing of a Medicare Cost Report.
CMS Home Healthcare Accountants define allowable bad debt in Provider Reimbursement Manual, Part I, Section 308 as debt that meets the following criteria:
The bad debt must be related to covered services and derived from deductible and coinsurance amounts.
- The provider must establish that reasonable collection efforts were made.
- The debt was actually worthless at the time of write-off.
- There is no likelihood of recovery of the debt in the future.
Recent CMS Home Healthcare Accountants rulings provide some clarification regarding these criteria. If the services of the Home Healthcare Accountants or clearing house are used by a facility, those bad debt claims must be returned to the facility and collection efforts discontinued before the debt is deemed “worthless”. The Home Healthcare Accountants rulings also suggest that Home Healthcare Accountants Firms or clearing houses must treat Medicare Cost Report claims in a similar manner.
To mitigate any potential adjustments or reductions in Home Healthcare Accountants Medicare reimbursement during the annual audit of the Medicare Cost Report, Home Health Agencies Accountants should take the time beforehand to carefully review and analyze their bad debt logs. If you have any questions or concerns about your bad debt listings and would like more information on VieraCPA Home Health Agency Accountants bad debt review services, please call us.
As the largest operating division of HHS, the Centers for Medicare and Medicaid Services (“CMS”) undergoes multiple scheduled program reviews by the OIG. As such, the Work Plan outlines the following areas of CMS evaluation:
- Hospital Capital Payments – The OIG will evaluate Medicare reimbursement to hospitals for capital expenditures (facilities and equipment) for appropriateness.
- Hospital Wage Data – Hospitals will be evaluated on the accuracy of wage data reported to CMS. Specifically, because the wage data reported is used to calculate wage indices for the Inpatient Prospective Payment System (“IPPS”), appropriate representation of this data remains critical.
- Critical Access Hospitals – The OIG will analyze payments made to Critical Access Hospitals; and, hospitals will additionally be evaluated on their ability to meet the criteria which defines a critical access hospital.
- Medicare Disproportionate Share Payments – OIG will (i) evaluate Medicare disproportionate share payments made to qualifying hospitals and (ii) analyze the total amount of uncompensated care at these hospitals.
- Hospital Readmissions – The OIG plans to assess trends related to hospital readmissions. Specifically, oversight in same-day readmissions will be critically reviewed.
- Diagnostic Imaging – According to CMS, increased use of diagnostic imaging services has proliferated during recent years. As such, evaluations on potential overuse and service costs will be conducted.
- Unbundled Laboratory Tests – The OIG plans to assess clinical laboratories which have unbundled laboratory tests to increase Medicare payments. Specifically, the extent of this inappropriate unbundling will be evaluated by analyzing claims data.
- Physician Reassignment of Benefits – Pursuant to the Social Security Act, physicians are not allowed to reassign Medicare beneficiaries except in the case of a specific exception. As such, the OIG will analyze reviews of such reassignments. In addition, an examination of physicians’ awareness of these reassignments will reveal the extent of these occurrences.
- Physician Identifier Number – The OIG plans to review Medicaid claims associated with invalid or inactive Physician Identifier Numbers; primarily, numbers used on claims after a physician’s death.
- Managed Care Organizations (“MCO”) – MCO’s will be evaluated based on Federal standards regarding fraud and abuse safeguards and marketing practices.
- Provider-Based Status – OIG plans to compile cost reports for hospitals claiming provider-based status for both inpatient and outpatient facilities. Based upon such reports, it will then identify hospitals improperly claiming provider-based status for facilities.
- Physician Hospice Billing – Based upon the standard that physicians should receive payments for hospice services solely under the Medicare Part B Physician Fee Schedule, the OIG will conduct reviews to identify whether physicians are double-billed (under Medicare parts A and B) for such services.
Physician Self-Referral for Durable Medical Equipment – OIG will conduct analyses to review the legality of physician referrals to durable medical equipment suppliers in which the physician holds ownership.