Oct 2016
Accurate, Complete Cost Reporting Is Key to Preserving Medicare Payment Rates 

Have you been happy with your Medicare payment rates for the home health and hospice services you provide to Medicare beneficiaries? You are partly responsible for them.

Providers need to be vigilant in their commitment to accurate and complete cost report data. The cost report is so much more than in informational tool, and has an impact on reimbursement by Medicare.  The goal of cost reporting needs to transcend the submission of an "acceptable" cost report, whether accurate or not, to ensure that Medicare payments are not withheld. On an individual basis, the cost report will not dictate an agency's specific Medicare reimbursement in the future. But, the Medicare cost report includes data that CMS can and will use to adjust overall home health and hospice payment rates. Incorrect data will contribute to a flawed payment system industry wide.

The home health rates for the years 2014-2017 are based on Medicare cost reports from 2011. The reimbursement rates for 2018 and beyond for both home health and hospice may be based, in part, on the cost reports providers file in 2017. The individual contribution to the Medical Cost Report data set affects all providers, so agencies need to be certain that their data is representative of their true business operations.

The FYE 9/30/16 cost reports are due to the MAC by February 28, 2017, and the FYE 12/31/16 are due by May 31, 2017. We recommend filing early and take advantage of Simione's special early-bird pricing.  For more information, contact Tom BoydVice President of Reimbursable Services, at 203-601-7206 or tboyd@simione.com.

Agencies Need to File the Medicare Credit Balance Report

Simione Healthcare Consultants reminds all Medicare certified providers to submit their Medicare Credit Balance Report.  If you have questions or need assistance with these activities, contact us.

What is 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. Examples of Medicare credit balances include instances where a provider is:
  • Paid twice for the same service either by Medicare or by Medicare and another insurer;
  • Paid for services planned but not performed, or for non-covered services;
  • Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts.
Why do you have to do it?
Medicare requires agencies to submit this report regardless of whether or not there is a balance to be refunded.  You may not have a credit balance due, but it is a necessary requirement that Medicare takes very seriously.  If you fail to submit a Credit Balance (CMS-838) Certification Page and/or identify all provider numbers, your Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370.
Where are the forms located?
Use the following link https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms838.pdf to obtain the Medicare Credit Balance Report.  If there are no credit balances to report, you'll only need to complete the Certification page and submit a copy to your MAC.  Subsequent pages include instructions and a Detail Page that you will need to complete if you DO have a credit balance to report.  

Viva Las Vegas! 
Simione Presents Sales Training & Compliance Education in December

Warm up and get ready for a New Year focused on growth and success in home health and hospice!  Simione Healthcare Consultants will host its longstanding Sales Training and a NEW Simione Compliance & Ethics Bootcamp in December, offering two opportunities to improve performance in home health and hospice.  Join us for these programs designed to help you incorporate and refine best practices in your sales, marketing and referral management, as well as compliance and risk reduction activities. 

Simione Sales Training
December 5-7, 2016
Springhill Suites, Las Vegas

Who should attend: Sales & marketing staff, including community liaisons, sales reps, sales managers and support roles for referral and admissions teams.

Dec 5: NEW Pre-Bootcamp $500 
(choose a track)
Track 1: Simione Sales Management Workshop or Track 2: Everything a Sales Professional needs to know about home health and hospice but didn't know where to ask. Reception @ 6 PM for attendees of the Sales Training & Compliance & Ethics Boot Camp 

Dec 6 & 7: Square One Bootcamp $895
8:30 AM - 5 PM
Complete 3-Day Package: $1,195 
(must specify which track for day one)
Simione Speakers
Mike Ferris, Principal
Kara Justis, MBA, Director
Melynda Lee, MBA, Senior Manager
Jeff Holm, Senior Manager

$149 per night

Increasing competition, developing networks and higher expectations from patients and families can threaten your opportunities for growth. Today's home health and hospice teams are realizing that the process begins with every conversation that occurs with potential customers. Our proven sales expertise and best practice strategies will help you analyze your sales process, and prepare your team for more productive relationships to grow referrals and admissions. 
Simione Compliance & Ethics Bootcamp 
December 5-7, 2016
Springhill Suites, Las Vegas

Who should attend: Executives, board members, compliance officers, directors, managers, coordinators and clinicians in companies interested in improving their compliance program or developing one. 

Dec 5: Reception at 6 PM for attendees of the Sales Training & Compliance & Ethics  Boot Camp

Dec 6 & 7: 8:30 AM - 5 PM 

Fee: $950 (includes reception, 
2-day program and lunches)

Simione Speakers
Kathleen Hessler, RN, JD, CHC, CHPC, Director 
Karen Bommelje, BSN, RN, HSC-D, CHC, Senior Manager

$149 per night

Government regulation, audits, case law and overpayment requirements create serious pressure to heed the guidance of the Office of the Inspector General, Department of Health & Human Services. The Affordable Care Act also requires that providers implement and maintain compliance programs. If you are a Medicare provider with a compliance program in place, the Federal Sentencing Guidelines provide for mitigation opportunities should a significant compliance issue arise. Our certified healthcare compliance experts will outline the essential elements of a compliance program and plan, offering strategies for maintaining an effective process to identify, address and minimize organizational risk specific to home care and hospice.


Oct 18
CT Association for Healthcare at Home Annual Conference & Expo, Hartford Marriott Downtown, Hartford, CT
Oct 23-25
Healthcare Enforcement Compliance Institute, Capitol Hilton, Washington, DC
Oct 23-25National Association for Home Care & Hospice Annual Meeting, Conference & Expo, Home is the Center of Health Care, Gaylord Palms Resort & Convention Center, Orlando, FL
Oct 31-Nov 2National Hospice & Palliative Care Organization - The Intensives: Mastering What's Next in Patient & Family Care, Diplomat Resort & Spa, Hollywood, FL
Nov 1-3Hospice & Palliative Care Federation of Massachusetts Annual Conference, Four Points Sheraton, Norwood, MA
Nov 10-12
American Association of Nurse Attorneys Annual Meeting & Educational Conference, Fairmont Hotel, Dallas, TX
Nov 17
New Jersey Hospice & Palliative Care Organization Hospice Team Conference, Sheraton, Eatontown, NJ

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