tci Medicare Compliance & Reimbursement - 2004 Issue 7

Home Care: New M+CO Appeals Burden Hits HHAs Hard

HHAs need to know what's required under the new mandate.Relationships between Medicare+Choice organizations and home health agencies are getting a lot less friendly - and they weren't that friendly to begin with - thanks to new fast-track appeals requirements.As required by a settlement in the Grijalva lawsuit, the Centers for Medicare & Medicaid Services began requiring new notices of termination of coverage for M+CO enrollees Jan. 1 to facilitate speedy appeals decisions. And the requirements for the fast-track appeals process are translating into extra costs and headaches for HHAs that contract with the Medicare managed care plans...

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