Home Health & Hospice Week

Location, time units now required, intermediary instructs.

Hospices that are used to pretty simple Medi-care billing are having to adjust.

Medicare is now requiring more line-item details on hospice claims, regional home health intermediary Palmetto GBA explains on its Web site.

"Over the past decade, Medicare has instituted progressively more complex payment methods," the RHHI notes. But hospices have been left out of the requirements--until now. "The limit of claims data has restricted Medicare's ability to ensure payment accuracy and to prudently analyze services provided in this benefit," Palmetto says.

Old way: Before, hospices had to use only "a small number of service lines to report the days and/or hours of the four levels of care," the intermediary says. "HCPCS codes were only required when reporting physician billing for procedures provided by hospice employed/contracted physicians."

New way: Now hospice claims must include HCPCS codes that indicate the location of services rendered, Palmetto instructs. Hospices can use the following codes:

Q5001--Beneficiary's home/residence

Q5002--Assisted Living Facility (ALF)

Q5003--Nursing Long Term Care Facility (LTC) or Non-Skilled Nursing Facility (NF)

Q5004--Skilled Nursing Facility (SNF)

Q5005--Inpatient Hospital

Q5006--Inpatient Hospice Facility

Q5007--Long Term Care Hospital (LTCH)

Q5008--Inpatient Psychiatric Facility

Q5009--Place not Otherwise Specified (NOS).

Units for most levels of care will stay the same. But hospices can no longer round continuous care to the hour and must report 15-minute units, Palmetto warns.

Example: Bill eight hours as 32 units. Enter nine hours, 45 minutes as 39 units, Palmetto advises.

Remember: Continuous care claims must reflect a minimum of eight hours of continuous care, Palmetto reminds providers. "Only direct patient care during a period of crisis is billable," it adds.

Resource: The Centers for Medicare & Medicaid Services issued a July 28, 2006 transmittal about the changes at www.cms.hhs.gov/transmittals/downloads/R1011CP.pdf.

Palmetto targeted continuous care for a probe last spring. (For tips on defending continuous care hours against scrutiny, see Eli's HCW, Vol. XV, No. 15)

• Three home health agencies successfully have settled their appeals over physical therapist compensation, reports their attorney, Joel Hamme with Powers Pyles Sutter & Verville in Washington, DC. The HHS Administrator had overturned Provider Reimbursement Review Board decisions for Broomfield, CO-based Colorado Home Care Inc., Kingston, PA-based Erwine's Home Health Care Inc. and Rockville, MD-based Potomac Home Health Care.

The three agencies appealed the reversals in federal court. The government paid 100 percent of the underlying claim and 100 percent of applicable interest to two providers and 100 percent of the underlying claim plus its attorney's fees to the last provider, Hamme reports.

The cases arose when the intermediary applied outside contractor salary limits to PTs employed directly by the agencies but paid per visit.

• Providers served by RHHIs United Government Services and Associated Hospital Service of Maine are seeing more changes resulting from the intermediaries' merger into parent company National Government Services (see Eli's HCW, Vol. XVI, No. 2).

UGS and AHS are keeping their original Web sites, but users first will be directed to the NGS portal site, NGS explains. "From the portal page, you will be able to click a link to the appropriate legacy Web site, which will remain unchanged at this time," the new contractor says.

A more substantive change is that UGS and AHS will start to consolidate Local Coverage Determinations (LCDs) and coverage articles, NGS says. "Some LCDs and articles may be retired in the early part of 2007," NGS says. "Beginning in mid 2007, new and revised policies will begin to be issued."

Any new policies will undergo the established advice and comment process, NGS assures providers. "In the meantime, existing LCDs and articles posted on the Medicare Database and contractor Web sites remain in effect for the states for which they were originally issued." NGS also includes DME MAC AdminaStar Federal.

• Power mobility suppliers should check out a new bulletin posted Jan. 26 by TriCenturion. The durable medical equipment program safeguard contractor (PSC) issued the bulletin, "Power Mobility Devices: Basic Equipment Package," as a guide to changes in the definitions of the basic equipment package for power wheelchairs.

Bottom line: For claims with dates of service on or after Jan. 1, some items that formerly were separately billable must now be included in beneficiaries' "initial issue" package.

To read the bulletin, go to www.tricenturion.com and select "Region A/B DME PSC."

• Home health agencies that want to see Medicare transmittals that apply only to their provider type can check out a new list of home health-specific transmittals at www.cms.hhs.gov/HomeHealthPPS/HHPPSTrans/TopOfPage. "The list begins with program transmittals released in December 2006," CMS notes in a Jan. 23 posting to its Web site. "As program transmittals are released, they will be added to this Home Health Transmittals list."

• JCAHO plans to list you on its Web site, whether you're accredited by the company or not. The Joint Commission on Accreditation of Healthcare Organizations will add non-accredited providers to its quality Web site at www.qualitycheck.org, it says in a message to potentially listed organizations.

The Oakbrook Terrace, IL-based accreditor plans to list providers "as a public service at no charge to the organizations being listed or to users," it says.

But JCAHO wants your two cents on how you're listed. "The Joint Commission is interested in the candid evaluation of the proposed directory listing format and content by those who are currently unaccredited," says JCAHO Associate Director Bill Spencer in the message.

A survey at www.jointcommission.org/healthcaredirectory "will provide those not currently accredited with an opportunity to comment prior to launching the revised website," Spencer says.

• How long do you need to retain electronic health records--and what's included in those records? A new federal rule effective Dec. 1, 2006 may have some home care providers scrambling for answers.

The so-called "e-discovery" rule spells out specifics about the gathering of evidence from electronic media, explains Michelle Dougherty of the American Health Information Management Association. It classifies e-mails and even instant messages as collectible data.

• Long-term care giant Manor Care Inc. is touting the growth of its home care and especially hospice business line.

A 28 percent surge in the business unit's revenues helped the Toledo, OH-based nursing home chain reach overall net income of $50.5 million on revenues of $934 million for the quarter ended Dec. 31, 2006, compared to a $32.3 million profit on $864 million in revenues for the same period in 2005.

"Led by gains in our hospice business, our hospice and home care business grew both sequentially and year over year and is now at an annual run-rate of over $500 million." Manor Care CEO Paul Ormond says in a release. "Organic growth and selective acquisitions have spurred hospice growth, and our average daily hospice census during 2006 increased by 35 percent compared with the previous year."

Manor Care is the nation's third-largest hospice provider based on average daily census, Ormond adds. "With more than 100 locations in 23 states, we serve more markets nationwide than any other hospice provider." The business line has grown in markets where the company "already has a highly regarded base of operations," the release says.

The company has invested in a multi-year project to upgrade its home care and hospice financial and clinical information systems, it adds.

• Hospice providers won some positive public relations last week. Syndicated New York Times columnist Jane Brody cast a spotlight on the value of hospice, highlighting humor columnist Art Buchwald's dying wish to make "hospice" a household word.

Buchwald, who died Jan. 17, completed his final book, Too Soon to Say Goodbye, while receiving hospice care. Buchwald spoke at the National Association for Home Care & Hospice's October 2006 annual meeting in Baltimore.