July 2015

CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2016


This week, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes to the Medicare home health prospective payment system for calendar year 2016 that will foster greater efficiency, flexibility and payment accuracy, and improve quality. Simione Healthcare Consultants is reviewing these changes, which reflect a broader strategy to create a health care system that supports higher quality, smarter spending and improved patient outcomes. Key areas of emphasis include: payment policy provisions, quality reporting and value-based purchasing.  Simione will publish a summary on the proposed rule at a later date.  



The Art of Ethics in Compliance and Clinical Activities


Home care and hospice organizations working to maximize their quality of care and financial performance are placing increasing emphasis on the development of ethics standards in their comprehensive compliance programs.  The role of ethics in compliance is paramount with the goals of sharing information and protecting organizations when individual and organizational values are challenged by patient/family concerns or quandaries about business practice.   


"We are operating in a high-risk environment where differences in values, opinions and preferences are pushing the limits for patients, families and providers," says Kathleen Hessler, RN, JD, Director of Compliance and Risk at Simione Healthcare Consultants. 


"How can you safely operate in an industry where what is legal, may be unethical, or what is ethical may be illegal? We recommend a clear process for 'doing the right thing', not simply because it is considered desirable, but because attention to values in a health care organization has significant implications for quality of care and reimbursement," Hessler explains.  

Medicare Credit Balance Report: 
What is this and why do you have to do it?


"A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors."


Medicare requires agencies to submit this report regardless of whether or not there is a balance to be refunded. Simione Healthcare Consultants has submitted these on behalf of clients for a number of years, and has yet to report a credit balance due.  However, it is a necessary requirement that Medicare takes very seriously.  If you fail to submit a Credit Balance (CMS-838) form and/or certification page with all provider numbers identified, Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370.


Benchmarking Basics with Simione Financial Monitor

As of March 31, 2015, the Simione Financial Monitor benchmark for Home Health Gross Profit Margin is 44% and for Hospice Gross Profit Margin is 42%.  Gross Profit Margin represents the operating margin for an agency.  For comparison purposes Gross Profit Margin is calculated in the Financial Monitor by taking the net payer revenue minus direct service costs. Direct service cost include salaries, benefits, contract, and mileage for direct care staff and any supplies or ancillaries used in direct patient care.   
Gross Profit Margin

Gross Profit Margin is a critical financial metric for an agency.  If an agency's Gross Margin is low they should first look at ways in which they can generate additional revenue.  Agencies should look into referral to admission conversion ratios, payer mix, case weight mix and average length of stay.  Agencies should also look into creating cost efficiencies in their direct operations through reviews of productivity, better supply or ancillary management, and improved patient coordination to reduce mileage costs.  Gross Profit Margin is a great starting point in any financial analysis as it should give the agency a road map to finding opportunities.

To learn more about the Simione Financial Monitor, email us or register for our complimentary webinar on July 15 at 2 PM Eastern.

Simione Leader Named Among "40 Under Forty" for Excellence in Finance, M&A

David J. Berman, CPA, CGMA, CVA, Principal, Simione Healthcare Consultants, has been selected to this year's distinguished panel of 40 Under Forty by the National Association of Certified Valuators and Analysts and Consulting Training Institute, recognizing his expertise and commitment to excellence in the fields of health care finance and mergers and acquisitions.


A Principal with Simione since 2006 who joined the company in 1998, David has 17 years of experience leading financial due diligence, business valuation, work flow and market assessment, and strategic planning for home health, hospice and private duty companies, including support for acquirers with the transition of ownership.  A seasoned national speaker, he has been instrumental in helping numerous organizations improve financial performance and business operations, having served as an interim financial executive in home health, hospice and private duty agencies. 

Advance Your Sales Leadership at Our 2nd Annual Sales Leadership Summit and Sales Training in September

Simione Healthcare Consultants is pleased to announce September dates for its 2nd annual Sales Leadership Summit and Square One Boot Camp sales training. Join us for these great opportunities to improve your referral management efforts!

September 14-16, 2015
Simione's 2nd Annual Sales Leadership Summit
 A Premier Home Care & Hospice Sales Management Event at The Cosmopolitan of  Las Vegas
Registration $2450 (early bird is $1950 through July 15; Room rate is $139/night

September 21-23, 2015
Square One Boot Camp
Home Care & Hospice Sales Training at Courtyard by Marriott, Chapel Hill, NC
This year, training is priced lower and with one less hotel night -- no need to travel on a Sunday! The training fee is $1,495 per person (formerly $1,895).  The training schedule is Monday 1 -5:30 pm, Tuesday, 8:30 am-5:30 pm, and Wednesday, 8:30 am-2 pm. Square One Boot Camp includes separate, specialized tracks for home care and hospice. 

July 21-23NHPCO 2015 Virtual Conference
July 28-30Home Care Association of Florida Annual Conference & Trade Show, Walt Disney World Dolphin Hotel, Orlando, FL
Sept 15-16Ohio Council for Home Care and Hospice Annual Conference, Hyatt Regency, Columbus, OH
Sep 17-18Home Care Association of NYS Senior and Financial Managers Retreat, Mohonk Mountain House Resort, New Paltz, NY
Sept 17-19

Nurse Next Door 8th Annual Conference, Cost Coal Harbour Hotel, Vancouver, WA



Founded in 1966, Simione™ Healthcare Consultants provides comprehensive business solutions for home health and hospice in the areas of finance, operations, cost reporting, compliance and risk,  sales and marketing, information technology, and mergers and acquisitions.  Simione's experts and tools support performance improvement across the healthcare continuum, engaging hospitals, health networks and agencies to improve quality, reduce costs, and minimize risk for more effective delivery of patient care.