Home Health & Hospice Week

You can reassure patients worried about the fate of Medicare under the Obama Administration's healthcare reforms can rest easy -- the administration will protect Medicare at all costs. "Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost," stressed President Obama to Joint Sessions of Congress last month. However, he restated his vow to ensure all seniors have adequate access to healthcare -- whether that care happens in a hospital, care facility, or senior's home.

"More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next," the president told Congress.

According to him, there are billions of dollars being wasted in fraud and "unwarranted subsidies in Medicare that go to insurance companies" that do nothing to improve care for seniors.

America's Health Insurance Plans is also going to bat to protect seniors' benefits under Medicare. "We are committed to working with policymakers and stakeholders to find savings in the Medicare program, including Medicare Advantage, but it is important to ensure seniors' healthcare choices are protected," the group said in a media statement.

Obama said savings could be used to "fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pockets for prescription drugs."

And he urged Medicare beneficiaries, as well as those who participate in the program, to not worry about the program going under. "That will never happen on my watch. I will protect Medicare," Obama said.

• When your patient changes from one Medicare payment source to another, you must complete a brand new OASIS assessment, regional home health intermediary Palmetto GBA reminded listeners in an Ask The Contractor teleconference held on October 6.

Example: A beneficiary under fee-for-service is receiving home care and elects a Medicare Advantage organization during the home health Prospective Payment System (PPS) episode. The episode should then end and you should ask for a partial episode payment adjustment. The MA organization is now the primary payer for a new episode, Palmetto instructs.

You'll use this same process for all eligibility changes that affect fee-for-service status.

• You can no longer submit Medicare Secondary Payer (MSP) claims or adjustments on paper, CMS says.

You must submit your MSP claims using the American National Standard Institute (ANSI) ASC X12N 837 4010-A1 format, according to Change Request 6426. This means CMS will reject any claims or adjustments sent in the wrong format.

Why: The change is designed to ensure that all providers submit as much information as CMS needs to process their claims and adjustments, according to the Change Request. For instance, many providers enter their adjustments directly into the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE); however, providers don't always use the CAS segments CMS needs to process their changes.

For those who meet the exception for submitting electronic Medicare claims, CMS has established a process for accepting paper claims. Eligible providers must submit their claims via FISS DDE showing Medicare as the primary payer. The claim will be rejected (and you must allow up to 75 days for processing). You can then submit your hard copy adjustment to the rejected claim that includes all information regarding payment from the primary payer source.

Good to know: If your software vendor doesn't support the 837 format, you can use PCAce Pro32, a free Microsoft Windows based claims submission software, CMS says.

For more information about this process go to https://www.cahabagba.com/rhhi/claims/msp/index.htm.

• Home care aides are working overtime to improve quality and increase patient satisfaction -- and their efforts are paying off.

Asurvey of more than 105,000 patients treated by nearly 900 agencies across the country found homecare patients' are highly satisfied with the care they're receiving, according to the 2009 Home Care Pulse Report: Patient Perspectives on American Health Care released on Oct. 9 by improvement solutions provider Press Ganey Associates.

The survey also found that:

♦ Occupational therapists received the highest rates of patient satisfaction.

♦ Satisfaction levels peak in the first few months of care.

♦ Satisfaction levels bottom out after twelve months of care.

♦ Medicaid and private pay patients were less satisfied than Medicare patients.

♦ Patients are more satisfied if they receive care in the morning than they are in afternoon.

Downside: The report wasn't all good news. Patients gave lower ratings for administrative procedures, the survey showed. These ratings could come back to haunt agencies, notes Press Ganey VP of home care Lisa Cone-Swartz.

Agencies must "focus on continuous improvement in light of proposed health care reform that may include home care and hospice in pay-for-performance, also known as value-based purchasing," Cone-Swartz says.

Read the Pulse Report at www.pressganey.com/HH_PulseReport_09.pdf.

• Worried about implementing HIPAA 5010? The Centers for Medicare & Medicaid Services has all the information you need to submit your claims correctly.

CMS has created a HIPAA 5010 Special Edition MLN Matters education article that outlines what challenges you'll face and how to plan for them.

You can access the article at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf.

But this won't be your last resource for nailing your 5010 transition. CMS will use Open Door Forums and listservs to share information about the implementation progress, the agency says.

• Agencies out to reduce their rehospitalization rates may need to look no further than a telemonitoring program.

New Jersey's Holy Redeemer Home Care and Hospice has created a program called Telehealth that remotely relays patient information such as weight, pulse rate, blood pressure, and blood oxygen levels to its staffers. The technology helps to detect health issues before they become so serious as to need rehospitalization, the group states.

Goals: Holy Redeemer hopes the Telehealth program will help patients stay in their homes for as long as possible. Since launching the program in 2007, Holy Redeemer patients have experienced "lower rehospitalization rates than the national average," which now hovers at 20 percent, says Sue Grinkevich, VP of home care for the nonprofit agency.

• Beginning on January 1, CMS will reimburse you $0.170 per international unit -- up from $0.164 in 2009 -- for the furnishing fee on all blood clotting factors not included on the Average Sales Price or Not Otherwise Classified files, according to Transmittal 1829 and Change Request 6673. Previously, CMS included the furnishing fee in the payment limit for HCPCS code J7197 (Antithrombin III [human], per I.U.). However, the code doesn't cover hemophilia clotting factor, leaving agencies holding the bag for the furnishing fee.

Read the transmittal at www.cms.hhs.gov/Transmittals/downloads/R1829CP.pdf.

• You have questions and Cahaba GBA has answers. After reviewing the topics agencies asked about most from July through September of this year, the RHHI has updated its Frequently Asked Questions Web page to better address home care agencies' concerns.

Cahaba wants staff members to contact its customer service reps only after they've exhausted all available self-service options, such as the FAQs, Cahaba ListServ, Interactive Voice Response system, and other resources.

You can view the updated questions and answers at www.cahabagba.com/faq.htm. Or request a print copy of the FAQs through the RHHI's Provider Outreach and Education department at (515) 471-7335.