This transcript has been auto generated
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hello and welcome to Hospice Insights
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the lawn Beyond where we connect you to
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what matters in the ever-changing world
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of hospice and palliative
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Care check the mail are you getting a 4%
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rate cut Jake Harris here you are yet
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again for like I think we're counting
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before the podcast began this is the
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fourth year we've been on the cycle of
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having conversations around this time of
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year it is it's certainly that time of
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year uh Midsummer uh when those dreaded
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letters come in um and and thankfully as
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we'll discuss in a little bit uh we've
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got a lot of experience dealing with
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them yeah it's like a mosquito like the
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mosquitoes swarm in July I got
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mosquitoes on the mine because it is wet
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and hot and humid here in little old
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Wisconsin which is also where you happen
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to be Jake too so that's right so
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mosquitoes come these hiis cap
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non-compliance letters come the same
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time and obviously what it was it last
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year they increased the penalty to
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4% and it was previously 2% and so this
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really does have I mean most people are
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running pretty small margins and so so
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if you're going to add um you know a ray
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cut it's pretty significant and I think
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that a lot of people probably were like
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I never have to deal with one of these
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non-compliance letters and then it's
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like well that's introduce you to Jake
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because Jake I don't know how many we've
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dealt with over the last four years and
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a lot you know they were all like good
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providers that for a whole variety of
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different reasons obviously Co played
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early on in these appeals in the first
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year or two but um a lot of good
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providers sometimes get these letters
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too because you could have had some
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snapu with goodness knows what so yeah
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yeah absolutely um that timeliness
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requirement is Relentless right where
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it's within 30 days of the event date
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that quality data needs to not only be
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reported or submitted to the government
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but also the data needs to be
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successfully accepted
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which oftentimes there are technical
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difficulties that prevent that from
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happening in a timely manner um and the
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system is fairly automated in terms of
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if you don't have 90% of the data
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reported within 30 days of the event
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date during the the applicable calendar
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year you will receive one of these
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letters um and I I I think the first
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step Meg is really to make sure that
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you're on the lookout for the letter
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itself um because that could come in in
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one of two ways uh it could come in the
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mail or it could come in your Casper
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folder so throughout the month of July
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and probably into August to be safe
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providers will want to be uh checking
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the Casper folder checking their mail uh
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to make sure that there is not one of
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these letters in there because
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unfortunately one defense that never
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works is to say well we didn't receive
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the letter yeah yeah exactly
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that that generally does does not work
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and then you're like proving a negative
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like well but I didn't get it and H that
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gets to be very testy and I think that
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even people who think like oh yeah I'm
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compliant my internal record show I'm
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fine um you still should look in these
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places because you said something really
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important is it needs to be SE
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successfully transmitted and in the
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years of working on these Appeals people
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thought they successfully transmitted
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things that for whatever reason did not
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and so so anyway there can just people
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might be expecting these letters they
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also could perhaps not be expecting them
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and then because maybe this isn't the
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case any longer but a lot of people
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didn't know like how to find this in
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their Casper file and stuff I know
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you've had to walk through with the
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number of clients like where to look for
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stuff and people are like I never go
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there sure and you know particularly
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depending on where you maintain your
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business address uh and where people may
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or may not have been working during the
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pandemic right there's a lot more remote
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work um you know things would get lost
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in the mail with a lot more frequency
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than maybe what we saw five or 10 years
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ago so be checking in person be checking
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electronically um again throughout the
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month of July and you know if you get
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one of these letters you want to catch
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it early because the reconsideration
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period typically closes sometime in mid
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August and we'll want to have time
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whether we're working with you or
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whether you're doing it yourself uh to
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prepare a reconsideration request that
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gives you the best chance of reversing
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this 4% penalty yeah so I think that we
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prior to four years ago I think I worked
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on like one or two of these and then now
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we've worked on countless to great
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success and I think
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to you know lawyers don't often feel
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like they work magic but I think clients
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felt like we worked some magic over the
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last couple years because they were
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pretty blown away that we were able to
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to win a lot of these and so I guess
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walk us through and and again Co was
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sort of an anomaly but last year we you
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know
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had success where covid was less of a
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factor and there was willingness to to
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consider facts and I I remember one of
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those cases there was a lot of issues
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around like people were a newly enrolled
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provider and so there was like delays
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with the mac and like getting whatever
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number you have to get to you know
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submit this stuff or whatever and so but
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tell us some of the things that you know
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go into to why you might get one of
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these letters and and what to do about
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it sure so what we touched on before uh
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technical difficulties with respect to
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the acceptance on the government's end
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of the data that the provider is
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submitting right so you might think well
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you know we're submitting these every
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couple weeks and so therefore with a
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30-day requirement we're absolutely
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going to be timely uh every time um but
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that's not necessarily the case if you
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haven't
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verified that the data was successfully
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accepted and then if it's not
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successfully accepted uh successfully um
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troubleshooting that within the 30-day
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period um so that it can be successfully
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accepted you know there there have been
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staffing issues right with with some of
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our providers where you know the right
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hand's just not talking to the left hand
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and thinks okay this person's got it
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I've assigned them to submit all the his
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data or all the Caps data um and it's
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just not getting done for one reason or
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another we know a lot of providers
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continue to face staff shortages even a
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couple years out from uh you know what
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we kind of consider the end of the
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pandemic uh and so that has caused uh
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some submissions to not be timely there
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are so there are any number of reasons
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the new the new provider example I think
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is a good one as well you know the the
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CMS requirement is that as soon as you
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receive that CCN notification letter
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that starts the clock that starts uh in
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in terms of your reporting requirement
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um and so then it's it's going to be 30
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days after each event date well there's
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oftentimes a difference between the time
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that you receive that letter and the
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time that you are technically set up uh
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with the capability necessary to submit
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the data um and so that's like the new
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provider example because yeah that gap
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between the CCN I got my number I'm all
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set to go and then yeah getting set up
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to submit as something totally different
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exactly exactly well you know those are
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all examples of of things that can
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happen um that would push your
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timeliness compliance rate for the
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calendar year below
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90% yeah and we've learned interesting
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and and really like Oddball things as
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we're working on this and one of the
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things was only two people like there
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can only be two logins or something and
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so like you have someone who an employee
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with a TR tragic event and then like
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trying to get that number I mean it's
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just there's some real limitations in
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how the system works and I to your point
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too because people are working from
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different locations like if I I know
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there's been thoughts about does
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internet connection like not uh somehow
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impact things or whatever I mean it's
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there's a lot of Oddball things that
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we've run into absolutely this process
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is ripe with pitfalls such that even the
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most diligent provider can easily fall
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below 90% in a given calendar year and
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you touched on a couple of them Meg one
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of which is the fact that the government
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actually only allows each provider to um
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designate two individuals to submit this
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data um on a regular basis and so that
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leaves you very little margin for error
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right because if one of those designated
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employees quits or suffers a death in
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the family or becomes ill uh or really
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if anything happens at all there's only
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one person left and if something happens
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to both of them at the same time um then
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you're scrambling to get new credentials
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uh you know from the government's end
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and so uh it it really is very easy to
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to have something like this happen often
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time providers come to us and they can't
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believe it right they try to do
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everything right yeah and and and they
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generally do things right um so
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certainly nothing to feel bad about but
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definitely something to look for and to
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act on if you do receive one of these
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letters well and as you're talking about
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the pitfalls it just makes me think
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about all these enrollment and
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deactivation issues we're we're having
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because sometimes you update your
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enrollment records and then the
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development request from the government
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goes to someone's email that hasn't
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worked at the organization for you know
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some time I was just on a call with a
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client recently where this person hasn't
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worked there for some time didn't submit
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the
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application but somehow was the one that
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got the development request and the way
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again I didn't know that this is how the
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way things work like if you tried to
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email this person internally you would
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get an undeliverable but if you emailed
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them from like your personal email
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address to the organization you're not
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getting a non deliverable because the
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first question was like well would have
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the government gotten a non deliverable
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or something and it's just like lots of
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weird stuff like it's just like things
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that are embedded in your profile about
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where things go and who gets what and
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because we've run into issues where
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where you know you've updated the
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government with whatever they need and
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then somehow their computer system
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reverts to using some like an address to
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your point from 10 years ago that you
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you know said I I moved from that
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location 10 years ago but that's somehow
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resurrected in the system and so anyway
276
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we're dealing with other very difficult
277
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situations because with deactivations
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your your revenue is cut off completely
279
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I mean 4% sense no fun but like 95% of
280
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my Revenue just stops because my
281
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medicare number is deactivated because
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of something went to some old email
283
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address or something I mean it's just so
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when you say rif with pitfalls I'm just
285
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these nightmares I'm dealing with with
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clients on deactivations it just brings
287
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very true so these are Arcane systems
288
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but unfortunately we have to deal with
289
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them yeah they're they're what we've got
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um and so there are yeah there are
291
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technical problems there are submission
292
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acceptance problems there are staffing
293
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issues um certainly during the pandemic
294
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um you know the toll that the illness
295
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itself took on hospice staff um you know
296
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combined with the efforts to get people
297
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vaccinated which diverted resources away
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from such things as Government reporting
299
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um you know these these are all things
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that we've been able to weave into the
301
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stories that we tell in seeking
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reconsideration of the the payment
303
00:13:28,839 --> 00:13:32,839
reduction uction the other thing we've
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been able to add as recently as last
305
00:13:32,839 --> 00:13:40,240
year because that penalty doubled from
306
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2% of the Apu to now 4% of the Apu is a
307
00:13:40,240 --> 00:13:45,399
goodfaith financial hardship uh argument
308
00:13:43,320 --> 00:13:47,360
that probably would not have resonated
309
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as well back when it was 2% but
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certainly at 4% um we've been able to
311
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say look you know this this could very
312
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well be the difference between the
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hospice's continued service of its
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community and its inability to operate
315
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all and and and we've made that argument
316
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again in good faith on behalf of of
317
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certain providers where the situation
318
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warrants yeah I forgot about that but
319
00:14:09,720 --> 00:14:18,560
you're exactly right and I do think that
320
00:14:13,440 --> 00:14:23,480
CMS has listened in these cases and you
321
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know it unlike some other uh appeal
322
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rights where you sometimes feel like
323
00:14:25,120 --> 00:14:30,480
it's a rubber stamp at least you know
324
00:14:28,079 --> 00:14:33,440
over these last years I feel like
325
00:14:30,480 --> 00:14:37,160
they've honestly taken a look at what
326
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we're saying and exercising discretion
327
00:14:37,160 --> 00:14:42,360
in I think a really wonderful way
328
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because people who are trying to comply
329
00:14:42,360 --> 00:14:47,160
and you did submit data I mean I'm
330
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thinking about you know EMR conversions
331
00:14:47,160 --> 00:14:52,800
and that screw something up or another
332
00:14:50,000 --> 00:14:54,800
thing that's plaguing people is people's
333
00:14:52,800 --> 00:14:57,040
you know median length of stay still
334
00:14:54,800 --> 00:14:59,399
hasn't recovered since covid and so
335
00:14:57,040 --> 00:15:02,399
there are still some hospices that you
336
00:14:59,399 --> 00:15:05,160
know their median length of stay is like
337
00:15:02,399 --> 00:15:07,600
nine days so you know all these things
338
00:15:05,160 --> 00:15:09,920
you're reporting your volume of the
339
00:15:07,600 --> 00:15:12,680
reporting is going up because your
340
00:15:09,920 --> 00:15:16,759
census is turning over so quickly and so
341
00:15:12,680 --> 00:15:18,680
I mean there's just a lot of things that
342
00:15:16,759 --> 00:15:22,440
as you and I have worked on these cases
343
00:15:18,680 --> 00:15:25,320
you discover about how difficult things
344
00:15:22,440 --> 00:15:27,480
really are for people and people are
345
00:15:25,320 --> 00:15:29,720
really wanting to comply it's not like
346
00:15:27,480 --> 00:15:31,720
people thumbing their nose that at this
347
00:15:29,720 --> 00:15:33,720
requirement and and these are all
348
00:15:31,720 --> 00:15:36,120
circumstances that we will help you
349
00:15:33,720 --> 00:15:38,319
think about when you consult with us I
350
00:15:36,120 --> 00:15:41,120
mean so many providers clients will come
351
00:15:38,319 --> 00:15:43,199
to us and they'll say well we dropped
352
00:15:41,120 --> 00:15:45,680
the ball we just messed up just didn't
353
00:15:43,199 --> 00:15:47,880
get to 90% and we'll probe them a little
354
00:15:45,680 --> 00:15:50,160
bit in a good way and say you know okay
355
00:15:47,880 --> 00:15:52,720
but what was going on last year right
356
00:15:50,160 --> 00:15:54,880
what are what are the real reasons why
357
00:15:52,720 --> 00:15:56,639
this happen because you know you're an
358
00:15:54,880 --> 00:15:59,040
otherwise compliant provider you're
359
00:15:56,639 --> 00:16:01,040
always trying to do the right thing um
360
00:15:59,040 --> 00:16:03,440
so you know tell us a little bit about
361
00:16:01,040 --> 00:16:05,440
Staffing tell us a little bit about you
362
00:16:03,440 --> 00:16:08,040
know technically how how this data is
363
00:16:05,440 --> 00:16:09,519
submitted and accepted from your end um
364
00:16:08,040 --> 00:16:11,240
you know tell us what was going on in
365
00:16:09,519 --> 00:16:14,160
the community in terms of the covid
366
00:16:11,240 --> 00:16:16,720
burden tell tell us everything uh that
367
00:16:14,160 --> 00:16:19,600
might have led to you are falling below
368
00:16:16,720 --> 00:16:21,079
90% uh for this particular year so that
369
00:16:19,600 --> 00:16:24,360
we can tell the most compelling
370
00:16:21,079 --> 00:16:27,079
narrative as to why you deserve to have
371
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this payment or this penalty reversed
372
00:16:27,079 --> 00:16:33,160
yeah I think that's exactly right right
373
00:16:29,240 --> 00:16:35,680
like people are like I'm just that's why
374
00:16:33,160 --> 00:16:37,880
in my little blurb description for this
375
00:16:35,680 --> 00:16:39,519
podcast the key takeways are don't
376
00:16:37,880 --> 00:16:41,440
assume there's nothing you can do
377
00:16:39,519 --> 00:16:44,519
because I feel like people fall on their
378
00:16:41,440 --> 00:16:46,880
sword when they shouldn't like of course
379
00:16:44,519 --> 00:16:49,040
we're not perfect right we're human so
380
00:16:46,880 --> 00:16:52,160
like human stuff happens so tell us
381
00:16:49,040 --> 00:16:53,959
about that human stuff because lawyers
382
00:16:52,160 --> 00:16:55,360
should be good storytellers and you're a
383
00:16:53,959 --> 00:16:57,279
great Storyteller you're a great
384
00:16:55,360 --> 00:16:59,880
litigator and that's what litigators
385
00:16:57,279 --> 00:17:02,560
hopefully can do is to to weave that
386
00:16:59,880 --> 00:17:05,400
narrative as you said but it is just
387
00:17:02,560 --> 00:17:08,559
people are saying like well it wasn't
388
00:17:05,400 --> 00:17:12,600
perfect and so anyway I think you're
389
00:17:08,559 --> 00:17:15,720
right is good lawyers ask good questions
390
00:17:12,600 --> 00:17:18,839
and we found out really meaningful stuff
391
00:17:15,720 --> 00:17:20,679
you know 20 questions in and we our
392
00:17:18,839 --> 00:17:24,760
light bulbs going on like hey there's
393
00:17:20,679 --> 00:17:28,319
something here that clients maybe felt
394
00:17:24,760 --> 00:17:30,400
like they didn't have so and don't wait
395
00:17:28,319 --> 00:17:33,120
cuz I know sometimes when we release
396
00:17:30,400 --> 00:17:36,320
this podcast we get a bunch of phone
397
00:17:33,120 --> 00:17:38,559
calls or sometimes it's like oh I just
398
00:17:36,320 --> 00:17:41,440
assumed I could do nothing and then I
399
00:17:38,559 --> 00:17:44,799
heard this podcast you know three weeks
400
00:17:41,440 --> 00:17:46,559
later and so it's it's been a Mad Dash
401
00:17:44,799 --> 00:17:48,679
the last four years to try to get all
402
00:17:46,559 --> 00:17:51,240
these in because there's we've worked on
403
00:17:48,679 --> 00:17:52,880
a lot of appeals but anyway try to stay
404
00:17:51,240 --> 00:17:55,000
ahead of it and that's why we're trying
405
00:17:52,880 --> 00:17:57,559
to stay ahead of it by doing the podcast
406
00:17:55,000 --> 00:18:00,280
like before the letters come out right
407
00:17:57,559 --> 00:18:02,480
so we're recording this on July 10th
408
00:18:00,280 --> 00:18:06,000
2024 and we're going to try to release
409
00:18:02,480 --> 00:18:07,360
this July 11th 2024 so I don't know if
410
00:18:06,000 --> 00:18:10,159
the letters have come out but we're
411
00:18:07,360 --> 00:18:12,600
trying to catch it early yes uh I mean
412
00:18:10,159 --> 00:18:14,880
we we have not heard from any clients uh
413
00:18:12,600 --> 00:18:18,000
that have received a letter uh as of
414
00:18:14,880 --> 00:18:20,240
July 10th cms's official communication
415
00:18:18,000 --> 00:18:22,919
says that they will begin notifying
416
00:18:20,240 --> 00:18:25,919
hospices of non-compliance uh in early
417
00:18:22,919 --> 00:18:28,200
to mid July 2024 in past years it's
418
00:18:25,919 --> 00:18:29,440
usually been more like mid July than
419
00:18:28,200 --> 00:18:31,120
early July
420
00:18:29,440 --> 00:18:34,120
and then typically the deadline to
421
00:18:31,120 --> 00:18:37,039
submit a reconsideration request uh
422
00:18:34,120 --> 00:18:39,760
asking for reversal of the 4% payment
423
00:18:37,039 --> 00:18:41,640
will be sometime in mid August it's
424
00:18:39,760 --> 00:18:43,559
usually on whatever that Friday is of
425
00:18:41,640 --> 00:18:46,159
mid August if I had to bet it'll be
426
00:18:43,559 --> 00:18:48,159
Friday August 16th this year uh but
427
00:18:46,159 --> 00:18:51,159
again we don't we don't have that date
428
00:18:48,159 --> 00:18:53,520
with certainty yet um but as Meg said
429
00:18:51,159 --> 00:18:55,360
definitely call us on the front end as
430
00:18:53,520 --> 00:18:57,159
soon as possible after receiving one of
431
00:18:55,360 --> 00:18:59,280
these letters the other thing I'll add
432
00:18:57,159 --> 00:19:01,760
is this is a multi-layer of appeel
433
00:18:59,280 --> 00:19:03,720
process if you want it to be typically
434
00:19:01,760 --> 00:19:06,799
for most providers given the amounts at
435
00:19:03,720 --> 00:19:10,000
stake versus the cost to litigate we go
436
00:19:06,799 --> 00:19:11,679
through the reconsideration phase only
437
00:19:10,000 --> 00:19:14,159
and another reason we do that is because
438
00:19:11,679 --> 00:19:16,600
as Meg has mentioned um we have had
439
00:19:14,159 --> 00:19:19,240
overwhelming success at that phase and
440
00:19:16,600 --> 00:19:21,159
have obtained reversals on behalf of the
441
00:19:19,240 --> 00:19:23,600
vast majority of clients on Whose
442
00:19:21,159 --> 00:19:26,799
behalves we've submitted reconsideration
443
00:19:23,600 --> 00:19:29,600
requests but th this is not a
444
00:19:26,799 --> 00:19:32,720
particularly burdensome or costly phase
445
00:19:29,600 --> 00:19:35,159
of appeal um this is not a situation
446
00:19:32,720 --> 00:19:37,200
where you're going to end up paying us
447
00:19:35,159 --> 00:19:39,480
you know anywhere close to the amount
448
00:19:37,200 --> 00:19:42,360
that's at stake when it comes to 4% of
449
00:19:39,480 --> 00:19:46,320
your Apu for the next fiscal year it it
450
00:19:42,360 --> 00:19:49,400
really is a modest and um fairly open
451
00:19:46,320 --> 00:19:51,200
and shut you know task for us to perform
452
00:19:49,400 --> 00:19:53,240
but we're going to want to talk with you
453
00:19:51,200 --> 00:19:55,799
again about the facts and circumstances
454
00:19:53,240 --> 00:19:58,760
surrounding the alleged non-compliance
455
00:19:55,799 --> 00:20:01,159
we're going to prepare a letter to CMS
456
00:19:58,760 --> 00:20:02,840
on your behalf seeking reconsideration
457
00:20:01,159 --> 00:20:05,480
we're going to collect the documentary
458
00:20:02,840 --> 00:20:07,000
evidence that'll support our request um
459
00:20:05,480 --> 00:20:10,480
and then we're going to submit it but it
460
00:20:07,000 --> 00:20:12,760
really is a a pretty streamlined process
461
00:20:10,480 --> 00:20:14,880
that you know so so so don't don't look
462
00:20:12,760 --> 00:20:17,159
at the size of the penalty and say ah
463
00:20:14,880 --> 00:20:19,840
well it's it's probably not even worth
464
00:20:17,159 --> 00:20:22,200
getting a lawyer involved um talk with
465
00:20:19,840 --> 00:20:25,280
us you know be open with us about the
466
00:20:22,200 --> 00:20:28,799
amount at stake uh we'll we we'll work
467
00:20:25,280 --> 00:20:30,280
with you and um again that that initial
468
00:20:28,799 --> 00:20:33,039
consideration phase where we've had a
469
00:20:30,280 --> 00:20:35,600
lot of success really not too expensive
470
00:20:33,039 --> 00:20:38,240
not too burdensome well and I guess
471
00:20:35,600 --> 00:20:41,760
maybe the final thing that I want to say
472
00:20:38,240 --> 00:20:44,760
it struck me as you're talking is don't
473
00:20:41,760 --> 00:20:46,520
wait like there is a process and I I
474
00:20:44,760 --> 00:20:49,559
can't remember the right word Jake where
475
00:20:46,520 --> 00:20:52,840
you can ask sort of you know in advance
476
00:20:49,559 --> 00:20:55,799
for a waiver because let's say you
477
00:20:52,840 --> 00:20:58,120
you've something did happen and like
478
00:20:55,799 --> 00:20:59,840
those can be granted and we've done that
479
00:20:58,120 --> 00:21:01,799
for some people where they felt like
480
00:20:59,840 --> 00:21:05,480
they weren't going to be compliant and
481
00:21:01,799 --> 00:21:08,240
they proactively asked for Grace
482
00:21:05,480 --> 00:21:11,279
essentially yes um you can seek an
483
00:21:08,240 --> 00:21:14,039
exemption or an extension uh with
484
00:21:11,279 --> 00:21:16,520
respect to part of the reporting period
485
00:21:14,039 --> 00:21:18,760
um in other words the data that is
486
00:21:16,520 --> 00:21:21,799
submitted and accepted outside of the
487
00:21:18,760 --> 00:21:23,480
30-day time frame from the event date if
488
00:21:21,799 --> 00:21:27,159
what's called an extraordinary
489
00:21:23,480 --> 00:21:29,799
Circumstance befalls the hospice now the
490
00:21:27,159 --> 00:21:32,120
term extraordinary circum St is not all
491
00:21:29,799 --> 00:21:34,279
that well defined which is extremely
492
00:21:32,120 --> 00:21:37,400
advantageous to Providers right because
493
00:21:34,279 --> 00:21:39,679
then we can couch almost anything that
494
00:21:37,400 --> 00:21:41,760
may have happened uh that prevented you
495
00:21:39,679 --> 00:21:44,320
from timely submitting data as an
496
00:21:41,760 --> 00:21:45,960
extraordinary Circumstance the key is
497
00:21:44,320 --> 00:21:48,279
that you need to seek an exemption or
498
00:21:45,960 --> 00:21:51,200
extension within 90 days of the
499
00:21:48,279 --> 00:21:53,440
extraordinary circumstance event so if
500
00:21:51,200 --> 00:21:56,440
you look over the over the course of the
501
00:21:53,440 --> 00:21:58,600
calendar year at whatever Point your
502
00:21:56,440 --> 00:22:00,840
non-compliance with the timeliness requ
503
00:21:58,600 --> 00:22:03,320
requirement ended right in other words
504
00:22:00,840 --> 00:22:05,480
when you started submitting data on time
505
00:22:03,320 --> 00:22:07,880
again you'll want to submit that
506
00:22:05,480 --> 00:22:11,799
extension or exemption request within 90
507
00:22:07,880 --> 00:22:14,919
days of of that time we find it we we've
508
00:22:11,799 --> 00:22:16,919
had great great excuse me success uh
509
00:22:14,919 --> 00:22:18,919
with extension and exemption requests as
510
00:22:16,919 --> 00:22:21,279
well and at worst it gives you a second
511
00:22:18,919 --> 00:22:23,559
bite at the Apple right you can request
512
00:22:21,279 --> 00:22:24,960
the extension or exemption and if CMS
513
00:22:23,559 --> 00:22:27,640
doesn't Grant it then you'll just
514
00:22:24,960 --> 00:22:29,559
receive a non-compliance notification in
515
00:22:27,640 --> 00:22:31,559
July of the following year and then we
516
00:22:29,559 --> 00:22:33,880
can do a reconsideration request so it
517
00:22:31,559 --> 00:22:36,080
kind of gives you two chances to Prevail
518
00:22:33,880 --> 00:22:39,919
yeah who knew Jake you were going to
519
00:22:36,080 --> 00:22:43,159
become the expert in all of the land on
520
00:22:39,919 --> 00:22:44,960
his and cap appeals it's a nice little
521
00:22:43,159 --> 00:22:49,600
cottage industry we've
522
00:22:44,960 --> 00:22:54,159
got so yeah anyway well I'm so glad that
523
00:22:49,600 --> 00:22:57,200
that you're here to to help um and it's
524
00:22:54,159 --> 00:22:59,720
been pretty terrific the results we've
525
00:22:57,200 --> 00:23:02,880
been able to get for folks so hope no
526
00:22:59,720 --> 00:23:06,120
one needs to listen to this podcast but
527
00:23:02,880 --> 00:23:09,279
given what we know like life happens and
528
00:23:06,120 --> 00:23:12,240
humans are humans that there is probably
529
00:23:09,279 --> 00:23:15,200
someone that needs to listen to this and
530
00:23:12,240 --> 00:23:18,000
we are people that can can be of service
531
00:23:15,200 --> 00:23:20,039
here so anyway thanks as always for your
532
00:23:18,000 --> 00:23:22,200
time Jake and maybe we'll have to do
533
00:23:20,039 --> 00:23:24,760
another podcast because we're going to
534
00:23:22,200 --> 00:23:27,880
have all these victories again I don't
535
00:23:24,760 --> 00:23:30,640
want to you know knock on wood uh that
536
00:23:27,880 --> 00:23:33,720
we be successful but well thank you for
537
00:23:30,640 --> 00:23:35,919
having me on Meg and I hope we are uh
538
00:23:33,720 --> 00:23:38,159
talking about another fresh batch of
539
00:23:35,919 --> 00:23:40,919
Victories uh sometime in the fall
540
00:23:38,159 --> 00:23:43,520
awesome thank
541
00:23:40,919 --> 00:23:46,240
you well that's it for today's episode
542
00:23:43,520 --> 00:23:48,440
of hospice insights Bel long Beyond
543
00:23:46,240 --> 00:23:50,520
thank you for joining the conversation
544
00:23:48,440 --> 00:23:53,919
to subscribe to our podcast visit our
545
00:23:50,520 --> 00:23:56,400
website at hush.com or sign up wherever
546
00:23:53,919 --> 00:24:00,360
you get your podcasts until next time
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May the wind be at your back