Health Law Daily Untimely vendor change results in late data submission, payment penalty
Monday, May 13, 2019

Untimely vendor change results in late data submission, payment penalty

By Kayla R. Bryant, J.D.

The Provider Reimbursement Review Board chided the home health agency for failing to properly oversee its new vendor.

A provider is responsible for ensuring that its vendors properly submit quality of care data on time. Abundant Home Health, LLC (Abundant) remained subject to a 2 percent penalty after the Provider Reimbursement Review Board (PRRB) found that CMS properly applied the penalty after Abundant missed the clearly established due date. The PRRB was not sympathetic to Abundant's explanation that an error occurred during its change in vendor at that time, resulting in the late submission (Abundant Home Health v. Palmetto Government Benefit Administrators, LLC, PRRB Hearing, Dec. No. 2019-D25, Case No. 17-1221, April 30, 2019).

Quality data submission requirements. Each year, home health (HH) prospective payment system (PPS) payments are increased by a market basket percentage. Home health agencies (HHAs) are required to submit quality data for all four quarters of the year in order to avoid a penalty of a 2-percentage point reduction in its annual payment update. CMS requires HHAs to submit the data on Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey results through approved vendors.

Abundant’s vendor transfer. Abundant submitted its quality data for the fourth quarter of 2015 after the deadline of April 21, 2016. The company stated that it was switching HHCAHPS vendors during this time, and provided evidence that the new vendor changed the old vendor’s authorization data in error, preventing the old vendor from submitting the data on time. Even though Abundant admitted that it did submit the data one day after the deadline, the company argued that the government should “avoid excessive penalty for minor or inadvertent violations.”

The PRRB disagreed with Abundant’s argument, pointing out that CMS had provided warnings to HHAs to monitor their vendors and that the deadline was firm, without exception. The PRRB found that it lacked authority to consider extraneous factors beyond what is explicitly contained in statutes and regulations. The penalty was upheld because it was properly applied.

Companies: Abundant Home Health, LLC; Palmetto Government Benefits Administrators, LLC; National Government Services, Inc.

MainStory: TopStory PRRBDecisions CMSNews HomeNews QualityNews

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