Home Health & Hospice Week
$10 Billion Medicaid Cut Pact Doesn't Rule Out Medicare Cuts
House and Senate finally agree on budget blueprint. By a slim margin, the U.S. House and Senate have agreed on a non-binding budget resolution that calls for $10 billion in Medicaid cuts over five years.
Originally, the House called for $20 billion in Medicaid cuts while the Senate approved no cuts (see Eli's HCW, Vol. XIV, No. 12, p. 95). But budget negotiators finally agreed on the $10 billion cut after concessions were made, including establishing a commission to examine Medicaid issues, according to press reports.
Medicaid cuts are bad enough news for home care providers. But the budget blueprint doesn't require lawmakers to stick solely to Medicaid to trim costs.
"While the lack of Medicare cuts is a positive sign to providers, a risk remains that the House Ways and Means and the Senate Finance Committees may seek cuts from certain [Medicare] providers if legislation moves forward to reverse scheduled cuts to physician payments," warns the National Association for Home Care & Hospice.
The outpatient therapy cap is another area that could leave legislators seeking funding cuts, cautions the American Association for Homecare. "To offset increased spending related to these two problems, they will be seeking between $25 billion and $40 billion over five years in program reductions elsewhere," AAH says.
And CMS seems eager to spread the success to other providers. "These early returns demonstrate that using financial incentives to reward better quality patient care works to deliver better care and avoid costly complications for our patients," CMS Administrator Mark McClellan says in a release.
If a CERT contractor decides your claim is "erroneous" because you failed to submit requested documentation, Medicare will send you a letter demanding that you refund the claim, CMS says.
You don't need to obtain your Medicare patients' specific authorization to forward their medical records to a CERT contractor, nor is this disclosure a violation of HIPAA, CMS stresses.
The Medlearn Matters article is at
Amedisys credits the success to strong internal growth of Medicare admissions and selective acquisitions. The company opened eight new locations in 2004 and plans 20 start-ups in 2005, it says. "Going forward, start-ups are expected to become an increasingly important part of our growth strategy," the company says in a release.
Dallas-based Odyssey's average daily census for the quarter was 7,609 and average length of stay was 85 days, it says. The Department of Justice announced an investigation against the hospice chain last fall (see Eli's HCW, Vol. XIII, No. 38, p. 302) and the company faces shareholder lawsuits.
Home Health Professionals, with eight offices, reported profits of $7 million in 2004, says Arcadia, which operates home care, staffing, mail order pharmacy and DME businesses.
Dr. Callie Hall Herpin and her co-defendant, office manager Etta Mae Williams, wrote at least 920 fraudulent CMNs and prescriptions and received about $184,000 in return, according to the Department of Justice. Various DME suppliers used the fraudulent CMNs generated by Williams and Herpin to bill Medicare in excess of $30 million.
Herpin also pleaded guilty to charges of illegally distributing 1.7 million hydrocodone tablets and 2,500 gallons of codeine cough syrup. She and Williams face a maximum sentence of five years in prison, three years supervised release and a fine of $250,000 on each of two conspiracy counts.
Mandated by the Medicare Modernization Act, the 15-member group will collect information, hold national town hall meetings and solicit comments via the Internet in order to come up with recommendations that will be presented to Congress and the Bush administration next year.
Motorola executive Randall Johnson will chair the group. Other members include Health & Human Services Secretary Michael Leavitt and Montye Conlan, an advocate for the disabled. More information is at
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$10 Billion Medicaid Cut Pact Doesn't Rule Out Medicare Cuts
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