By Leah S. Poniatowski, J.D.
ACA provision to curb Medicare fraud and waste kicks in to place high-risk provider and supplier types under temporary supervision.
New Medicare-enrolled home health agencies, a provider type with a record of high levels of fraud, waste, and abuse, should look for notification from CMS that they will be placed under watch for a "provisional period," authorized by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), according to CMS’ Medicare Learning Network (CMS MLN Matters® Special Edition Article, SE19005, February 15, 2019).
Background. In a measure to help reduce fraud, waste, and abuse of Medicare benefits, the ACA included a section authorizing CMS to implement a provisional period of enhanced oversight for new provider and supplier types that are well known to engage in those detrimental acts. Home health agencies and suppliers receiving Medicare are among the types that the government identified as engaging in a high level of fraud and abuse.
Scope of oversight. According to the article, new agencies and suppliers are the focus of the initial use of the enhanced oversight, and will receive notification from CMS or one of its contractors. Providers and suppliers may be subject to the supervision beginning February 15, 2019, when the article was issued. The enhanced oversight will entail suppression of upfront Request for Anticipated Payment (RAP) payments during the period identified in the notification letter, which may range from 30 days up to one year. Although the agency or supplier will not receive payments for RAPs during this time, they must still submit the RAPs for each home health episode in order to ensure payment when the final claim has been submitted.
Distinct from final rule. CMS clarified that the authority underscoring the enhanced supervision from the ACA is not related to the recently published final rule (83 FR 56406, November 13, 2018) on Medicare which eliminates RAP payments for new agencies as of January 1, 2020.
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