Home Health & Hospice Week

Many agencies are groaning under software burden.

Home health agency staff rang in the New Year with lots of extra headaches related to the prospective payment system changes that took effect Jan. 1.

The changes finalized last August require numerous billing and OASIS adjustments, including the switch to a new three-tiered therapy threshold, addition of separate nonroutine supplies (NRS) reimbursement and grouping based on the early/late episode designation indicated in M0110.

Many Louisiana HHAs had “healthy anxiety” about the billing changes ahead of time, relates Warren Hebert with the HomeCare Association of Louisiana. It’s normal to have “pre-submission jitters” when such a drastic payment system change is on deck, says Lynn Olson with Astrid Medical Services, a Corpus Christi, TX-based billing company.

Many agencies are experiencing burdens with their billing software vendors during the transition, reported some of the trade groups in all 50 states and Puerto Rico contacted by Eli. “It is a nightmare. We are awaiting our third fix from our computer vendor,” reports one Wisconsin HHA. The agency can’t lock OASIS and has not attempted to bill yet, it says.

More commonly, agencies’ vendors were ready, but only with a number of time-consuming software updates. Most vendors seem to be sending “daily edits” and other fixes, notes Vicki Purgavie with the Home Care Alliance of Maine.

“We are in the same boat as everybody else--adding patches to patches on our computer system,” laments a Wisconsin agency. “We have had to run an upgrade to the upgrade and will probably have to run more upgrades as the bugs get worked out,” another Badger State provider adds.

A number of vendors were “cutting it close,” adds Karen Hinkle with the Kentucky Home Health Association. That put extra stress on providers trying to get ready for the changes.

Who’s to blame? But many of the updates were due to CMS issuing notices at the last minute about grouper software changes (see Eli’s HCW, Vol. XVI, No. 41) and payment errors (see Eli’s HCW, Vol. XVI, No. 44-45). The Medicare system won’t pay you correctly for some wound items and diagnosis coding combinations and you won’t receive the correct reimbursement unless you resubmit for it.

There’s been “some understandable frustration from members about the last minute changes to the grouper and CMS laying off the responsibility of finding and correcting them on us,” notes Bob Wardwell with the Visiting Nurse Associations of America.

“Why did they not put it off until they knew what they were doing?” one West Virginia HHA asks of the billing changes. “Isn’t that something what the government can get away with?” the provider says of not having to correct the payment mistakes.

PPS Claims Submission Delayed

In addition to software issues, providers are grappling with the ins and outs of payment methodology and its new OASIS and billing requirements. Providers are still confused about how to check for episode sequence for M0110, reports M. Aaron Little with BKD in Springfield, MO. (For tips on answering M0110 accurately, see Eli’s HCW, Vol. XVI, No. 29).



In fact, many agencies are so consumed with software and methodology changes that they haven’t submitted any claims yet under the PPS revisions. “We are closing out 2007,” says one Nebraska HHA.

Agencies are still working on getting the HIPPS codes correct for episodes under the changes, the Wisconsin agency adds. “Most of our clients haven’t sent us any new PPS billing yet,” Little agrees.

Many agencies didn’t submit any RAPs because of holiday disruption, says William Dombi with the National Association for Home Care & Hospice.

“Overall providers are still working on ways to improve their internal structures and processes necessary to be efficient under the new PPS changes,” believes Marcia Tetterton with the Virginia Association for Home Care.

Or they are just submitting their first RAPs now, says Kathleen Anderson with the Ohio Council for Home Care. “The SOCs are just being submitted and the RAPs are being billed,” she reports.