Home Health Care Accounting Is Challenging

Home Health Care Accounting Is Challenging

Home Health Care Accounting Is challenging, not because it’s different from other accounting practices, because of the level of detail your financial statements must have in order to properly file your Home Health Care Agency Medicare Cost Reports.

Our Home Health Care Accounting services specialize in the field of home health care accounting, Medicare Cost Reports and other regulatory requirements.

The narrower aim of home health care accounting and our Home Health Care Accountants  is to assemble and structure information on the health care system that is needed to hold the providers of health care formally accountable for the cost and the quality of the products and services they deliver.  Our Home Health Care Accountants seek to measure the financial outcome of the myriad decisions made in a business during a quarter or full year.

The challenges of home health care accounting can be illustrated the chart below:

The fundamental statement in this chart is the company’s statement of financial position. It presents dollar estimates of the real, financial and intangible assets to which the company has legal title, all of the debt it owes and the difference between total assets and total debt, which is the company’s net worth, also called owners’ equity.

Health Care Accounting Accountants understand the reporting requirements of a Home Health Care Agency via the Medicare Cost Reports. A typical business can group all its sub-contractors into a single line item on its financial statements. Home health care accounting is much different. You must track and break out the individual disciplines of the sub-contractors on your financials (i.e. PT, OT, ST, HHA etc). If these are grouped together, preparing your Medicare Cost Report will be a nightmare. Furthermore, the corporate tax returns must match the Medicare Cost Reports. Which means that if you’re chart of accounts is not sufficiently detailed the preparation of both your Medicare Cost Reports and corporate tax returns will be impossible.

A rejection of your Medicare Cost Report by Palmetto GBA could mean your payments from Medicare will be suspended.

Our Home Health Care Accountants specialize in home health care accounting. Please call us for a free initial consultation and assessment of your accounting records to ensure a smooth year end and subsequent filing of your tax returns and Medicare Cost Reports.



Healthcare Accountants in Miami

Healthcare Accountants in Miami

Healthcare Accountants in Miami, Gustavo A. Viera CPA, stated that the Centers for Medicare and Medicaid Services announced on August 10, 2011 that it will begin sending revalidation requests by mail to nearly 1.5 million health professionals, more than half of whom are physicians. These notifications are already being sent and will continue until March 23, 2013.

CMS has implemented new screening criteria for all Medicare applications in an effort to weed out individuals and institutions that shouldn’t have billing privileges, according to VieraCPA Healthcare Accountants in Miami. There is, however, a great concern expressed by many physician organizations that legitimate physicians and other Healthcare Agency professionals could mistakenly get caught up in this enrollment sweep, according to VieraCPA Home Healthcare Accountants.

We aren’t joking about checking your mail, says VieraCPA Healthcare Accountants in Miami. Once you receive the request, you will have sixty days to recertify your enrollment information. CMS is playing hardball: “Failure to submit the enrollment forms as requested may result in a deactivation of your Medicare billing privileges” according to according to VieraCPA Healthcare Accountants in Miami.

Note that this recertification is also required for clinics and group practices. And, as you might expect, Healthcare Accountants in Miami anticipate that the notifications for the physicians in a large group practice might arrive in a “piece meal” manner. Diligence is required on behalf of you and your staff to avoid having your Medicare billing privileges deactivated, says VieraCPA Healthcare Accountants in Miami.

New Federal poster Requirements

The notification goes into further discussions regarding Healthcare Accountants in Miami what it is illegal for an employer to do, as well as what it is illegal for a union that represents an employee to do.

Healthcare Accountants in Miami experts say the background to this situation is that this is actually a rule put forth by the National Labor Relations Board. It was not passed by the Congress nor was it signed by the President.

What does this do to Your Practice?

What this does is effectively inform your employees that they do have the right to organize. It is widely understood that the Service Employees International Union (SEIU) has specifically targeted the Southeast, where there are a number of right to work states, with the intent of organizing. The healthcare industry, being obviously a significant service industry, is one of the key targets, according to Healthcare Accountants in Miami experts VieraCPA.

This being said, understand that if an employer knowingly and willfully even fails to post the notice, the failure may be considered as evidence of unlawful motive in an unfair labor practice case. The recommendation is that you watch for any implementation delays (there are a number of legal challenges of this requirement) and, assuming no change comply by Monday, November 14th. As practices become larger and larger due to mergers and other consolidations, it may inevitable that at some point or another, unions may approach your employees, or your employees approach unions.

HIPAA Enforcement Intensifies

The implementation of the HITECH Act under the ARRA in early 2009, and the recent refining of the regulations related to the enforcement of HIPAA by the Office of Civil Rights (OCR), has increased the scrutiny that healthcare organizations may undergo. In July 2011, the Office of Civil Rights awarded $9.2 million dollars to KPMG to conduct HIPAA compliance audits under the guidance of the Department of Health and Human Services staff. Under this program, there will be 150 audits varying in size and scope.

Of note in the discussion surrounding this project is the fact that most of the significant violators of late have been major institutions.

For example, UCLA Medical Center, Massachusetts General Hospital, and Cignet Health of St. George County Maryland. Mainly because of the publicity focused around HIPAA violations in national news coverage, there appears to be an increased awareness on the part of the general public about it. From January 1, 2010 thru December 31, 2010 there were 9,158 HIPAA complaints reported to the Office of Civil Rights nationally. Of those, 54% were resolved after intake and review. Of the remaining 4,229 cases that required investigation, in 2,703 (64%) the OCR required corrective action.

It’s worth taking a look at how this process works. As to how important cooperation is, in the case of Cignet, mentioned previously, $3 million of their $4.3 million fine was related to the fact that they failed to cooperate with OCR’s investigation on a continuing daily basis. This was perceived by the OCR as a willful neglect on behalf of Cignet to comply with the Privacy Rule.

Additional guidance will be forthcoming from CMS regarding specific issues related to the enforcement of the Security Rule under the HITECH Act. Look for this information to be published by CMS in the fall of 2011.

The Office of Civil Rights is seriously taking into account the severity of any privacy or security breach. There is what is known as a “threshold risk of harm” analysis that requires four steps. These are as follows:

  •  What was the nature of the data elements breached?
  • What is the likelihood that the information is accessible and usable?
  • What is the likelihood that the breach may lead to harm?
  • What is the ability of the covered entity to mitigate the risk of harm?

Some of the many breaches that have occurred have related, for example, to the theft of laptops containing protected health information (PHI). In many of these cases, the nature of the elements breached was significant in that it related to PHI. However, the likelihood that the breach could lead to harm was minimal due to the security systems that had been implemented and enforced. Simply stated, it was likely the thieves wanted the laptop and had no interest whatsoever in the PHI that it contained.

In fact, in some cases, the laptops have been recovered at pawn shops, etc. by law enforcement agencies and the covered entity has determined that the information was never accessed.

Healthcare Accountants in Miami VieraCPA are always available to assist you with questions related to the enforcement of HIPAA. Over the past few years we have had a number of situations in which our clients have been involved in breaches of PHI. Many of these were simply violations of common sense, others were due to carelessness. Fortunately we can state that none of them were done in a vindictive or truly harmful manner. Nonetheless, you need to be vigilant, constantly train your staff and keep them updated on HIPAA requirements.

Also be aware that a number of government agencies are involved in HIPAA enforcement. Aside from the HHS Office of Civil Rights, the Federal Trade Commission Bureau of Consumer Protection, the Centers for Medicare and Medicaid Services, as well as the Attorney General in your state may become involved.


Miami Home Healthcare Accountants Bad Debt Recovery

Miami Home Healthcare Accountants Bad Debt Recovery

Miami Home Healthcare Accountants Gustavo A Viera CPA we’re concerned as the economic recession continues and with the rise in unemployment, Home Healthcare Accountants must deal with accelerated growth in bad debts in addition to the myriad of other financial and operating challenges presented during the downturn. Home Health Agency Accountants understand that while all bad debts cannot be recovered, 70% of allowable Medicare bad debt claims, including Medicaid cross-over balances, can be salvaged through the filing of a Medicare Cost Report.

CMS Home Healthcare Accountants define allowable bad debt in Provider Reimbursement Manual, Part I, Section 308 as debt that meets the following criteria:

The bad debt must be related to covered services and derived from deductible and coinsurance amounts.

  • The provider must establish that reasonable collection efforts were made.
  • The debt was actually worthless at the time of write-off.
  • There is no likelihood of recovery of the debt in the future.

Recent CMS Home Healthcare Accountants rulings provide some clarification regarding these criteria.  If the services of the Home Healthcare Accountants or clearing house are used by a facility, those bad debt claims must be returned to the facility and collection efforts discontinued before the debt is deemed “worthless”.  The Home Healthcare Accountants rulings also suggest that Home Healthcare Accountants Firms or clearing houses must treat Medicare Cost Report claims in a similar manner.

To mitigate any potential adjustments or reductions in Home Healthcare Accountants Medicare reimbursement during the annual audit of the Medicare Cost Report, Home Health Agencies Accountants should take the time beforehand to carefully review and analyze their bad debt logs. If you have any questions or concerns about your bad debt listings and would like more information on VieraCPA Home Health Agency Accountants bad debt review services, please call us.

As the largest operating division of HHS, the Centers for Medicare and Medicaid Services (“CMS”) undergoes multiple scheduled program reviews by the OIG.  As such, the Work Plan outlines the following areas of CMS evaluation:

  • Hospital Capital Payments – The OIG will evaluate Medicare reimbursement to hospitals for capital expenditures (facilities and equipment) for appropriateness.
  • Hospital Wage Data – Hospitals will be evaluated on the accuracy of wage data reported to CMS.  Specifically, because the wage data reported is used to calculate wage indices for the Inpatient Prospective Payment System (“IPPS”), appropriate representation of this data remains critical.
  • Critical Access Hospitals – The OIG will analyze payments made to Critical Access Hospitals; and, hospitals will additionally be evaluated on their ability to meet the criteria which defines a critical access hospital.
  • Medicare Disproportionate Share Payments – OIG will (i) evaluate Medicare disproportionate share payments made to qualifying hospitals and (ii) analyze the total amount of uncompensated care at these hospitals.
  • Hospital Readmissions – The OIG plans to assess trends related to hospital readmissions.  Specifically, oversight in same-day readmissions will be critically reviewed.
  • Diagnostic Imaging – According to CMS, increased use of diagnostic imaging services has proliferated during recent years.  As such, evaluations on potential overuse and service costs will be conducted.
  • Unbundled Laboratory Tests – The OIG plans to assess clinical laboratories which have unbundled laboratory tests to increase Medicare payments.  Specifically, the extent of this inappropriate unbundling will be evaluated by analyzing claims data.
  • Physician Reassignment of Benefits – Pursuant to the Social Security Act, physicians are not allowed to reassign Medicare beneficiaries except in the case of a specific exception. As such, the OIG will analyze reviews of such reassignments.  In addition, an examination of physicians’ awareness of these reassignments will reveal the extent of these occurrences.
  • Physician Identifier Number – The OIG plans to review Medicaid claims associated with invalid or inactive Physician Identifier Numbers; primarily, numbers used on claims after a physician’s death.
  • Managed Care Organizations (“MCO”) – MCO’s will be evaluated based on Federal standards regarding fraud and abuse safeguards and marketing practices.
  • Provider-Based Status – OIG plans to compile cost reports for hospitals claiming provider-based status for both inpatient and outpatient facilities.  Based upon such reports, it will then identify hospitals improperly claiming provider-based status for facilities.
  • Physician Hospice Billing – Based upon the standard that physicians should receive payments for hospice services solely under the Medicare Part B Physician Fee Schedule, the OIG will conduct reviews to identify whether physicians are double-billed (under Medicare parts A and B) for such services.

Physician Self-Referral for Durable Medical Equipment – OIG will conduct analyses to review the legality of physician referrals to durable medical equipment suppliers in which the physician holds ownership.

Given the aforementioned items, Home Health Agency Healthcare Accountants and physicians should assess both operational and financial relationship matters in order to ensure proper compliance moving forward into 2010.