CMS Names Latest Round of RAC Contracts – On October 31, 2016, CMS announced it awarded contracts for its Medicare Fee-for-Service Recovery Audit Contractors (RAC) to Performant Recovery, Inc. (Region 1), Cotiviti, LLC (Regions 2 and 3), HMS Federal Solutions (Region 4), and Performant Recovery, Inc. (Region 5). The Region 1-4 RACs are tasked with postpayment reviews to identify and correct Medicare over- and underpayments made under Parts A and B.  Their reviews involve all provider types except Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice.  Performant Recovery, Inc. (Region 5) will conduct postpayment reviews of  DMEPOS and Home Health/Hospice claims nationally.  For maps showing the regions and related RACs, click here and go to downloads.

CMS Issues Final Rule on 2017 Payments for Home Health Agencies – On Thursday, CMS published the 2017 PPS Final Rule for Home Health Agencies, reducing Medicare payments by an estimated $130 million, or 0.7 percent. Noting that the changes reflect the broader Administration goal to reduce spending by focusing on quality care, CMS emphasized that changes in the rules focus on prevention, achieving better health outcomes, and improvements in disease management. In a statement, the National Association for Home Care & Hospice noted that, while the changes in the Final Rule were generally unsurprising, it “remains concerned for the erosion of home health care access caused by rate reductions.”   The CMS Final Rule is available here. The NAHC statement is available here.

CMS Increases Value-Based Incentive Payments for FY 2017 – CMS estimates that approximately $1.8 billion will be available for the Hospital Value-Based Purchasing (VBP) Program for FY 2017 under the Inpatient Prospective Payment System. To create the $1.8 billion fund, CMS reduced base DRG payments by two-percent, which will then be redistributed to hospitals that perform well under the VBP Program. The Hospital VBP Program is one of the many ACA Programs focused on moving away from fee-for-service payments and instead structuring payments based on quality of care. Hospitals’ payments under the program are based on Clinical Care (30 percent), Patient and Caregiver Centered Experience of Care/Care Coordination (25 percent), Safety (20 percent ), and Efficiency and Cost Reduction (25 percent).  CMS also set new program requirements for FY 2018. The CMS Press Release is available here.