Home Health & Hospice Week

Since the prospective payment system began in 2000, home health agencies have undergone relatively light supervision, many experts agree. But the Obama administration's fraud and abuse fighting has ramped up and HHAs would be prudent to protect themselves with an up-to-date compliance plan. (For more compliance plan information, see Eli's HCW, Vol. XIX, Nos. 23 & 29.)

Blast from the past: "We need to be prepared for more scrutiny," believes Joie Glenn of the New Mexico Association for Home and Hospice Care. Providers may need to be "reminded of topics that were discussed 'back when' and perhaps are on the shelf instead of front and center in the agency," Glenn tells Eli.

1. Therapy is a hot button topic, notes attorney Robert Markette Jr. with Gilliland & Markette in Indianapolis. "In light of the recent Wall Street Journal article and the Senate inquiry, providers should be especially sensitive to issues related to therapy utilization and medical necessity of therapy visits," Markette advises. The HHS Office of Inspector General has been casting suspicion on therapy gaming for years, Markette adds.

The Centers for Medicare & Medicaid

Services has shown its focus on therapy with its sweeping therapy documentation requirements proposed in the 2011 PPS rate update (see Eli's HCW, Vol. XIX, No. 28, p. 218).

Do this: "Providers should be routinely auditing claims for episodes with therapy visits," Markette counsels. "They should verify the documentation supports the medical need for the therapy."

Plus: HHAs should assess their overall therapy utilization. "If patients are routinely receiving 14 therapy visits, that is the sign of a problem," Markette warns.

2. Homebound status continues to plague agencies' compliance efforts, notes attorney Marie Berliner with Lambeth & Berliner in Austin, Texas. It's a longstanding issue, she notes.

This is an area the OIG has flagged as a risk area, points out attorney Julie Mitchell with the Mitchell Day Health Law Firm in Ridgeland, Miss.

3. Marketing is another risk-laden area, says attorney Liz Pearson with Pearson & Bernard in Edgewood, Ky.

"Issues related to marketing are extremely important," stresses Washington, D.C.-based health care attorney Elizabeth Hogue. "There are marketing reps out there who are 'off the farm' because they don't know any better," she warns.

4. Referrals are an area rife with compliance risk, Berliner points out. "The government has expressed interest in looking at relationships" with referring physicians, medical directors, and referring facilities and providers, she notes.

5. Medicare/Medicaid issues are another concern. There may be problems due to differences between Medicare and Medicaid home health requirements, Markette suggests.

6. Billing is an area with numerous risks, experts agree. "Making sure the work that is billed for was actually performed as billed is extremely important," emphasizes attorney Ross Lanzafame with Harter Secrest & Emery in Rochester, N.Y.

Tip: "Self-auditing would be advisable at the very least for this aspect of HHA operations," Lanzafame urges.

7. Audit topics for Medicare contractors like Recovery Audit Contractors or Zone Program Integrity Contractors (ZPICs) are a good indicator of where you should be focusing your compliance efforts, Berliner suggests. RACs particularly go for "low hanging fruit," she notes.

8. Medical necessity is an oldie but a goody as far as risk areas, attorneys point out.

9. Outliers. CMS put 10 percent outlier caps in place in January, but that doesn't mean the agency is now ignoring the area that has caused major fraud and abuse problems for the Medicare program. Outlier billing continues to be a hot spot for the feds, Berliner believes.