Home Health & Hospice Week
ANOTHER FRAUD CONTRACTOR MAKES DEBUT
CMS names third ZPIC. The third Zone Program Integrity Contractor (ZPIC), Rockville, Md.-based Background: The Centers forMedicare & Medicaid Services is awarding ZPIC contracts in seven zones. ZPICs will take over PSCs' program integrity functions. CMS already has announced the contracts for zones four and seven and the contractors have begun operating (see Eli's HCW, Vol.XVIII, No. 13, p. 99). Last month, CMS issued a draft of its final solicitation for the remaining ZPICs in zones 3 (Minnesota, Wisconsin, Illinois, Michigan, Ohio,and Kentucky) and 6 (Pennsylvania, New York,Maryland, DC, Delaware, Maine, Massachusetts,New Jersey, Connecticut, Rhode Island, New Hampshire, and Vermont), according to the federal government's Federal Business Opportunities Web site, which lists vendor contract details. • The Department of Health and Human Services has declared a national public health emergency over swine flu, but don't think that will let you out of any regulatory requirements. The emergency declaration is the same as those issued for natural disasters like Hurricane Katrina and recent flooding, HHS notes. But unlike with those declarations, HHS "has not declared a waiver of requirements under section 1135 of the Social Security Act (SSA),"warns the National Association for Home Care & Hospice. "Providers will have to wait for the secretary to authorize waivers under section 1135 before any regulatory waivers can be initiated." • More bad news for the home medical equipment industry came out of a Senate subcommittee hearing on April 22 that focused on Medicare fraud. In addition to the OIG's damaging testimony on oxygen also given in a Senate roundtable the previous day (see Eli's HCW, Vol. XVIII, No. 16, p.126), CMS touted competitive bidding as a fraud prevention program--an idea that many lawmakers seem to be buying. "Home medical equipment -- DMEPOS --is an industry that is historically at high risk for fraud," CMS's Deb Taylor said in prepared testimony. "One important tool to help fight DMEPOS fraud is competitive bidding for DMEPOS suppliers." CMS also highlighted its Stop Gap Plan (see related story, p. 133). The program "increases prepayment reviews of medical equipment suppliers and will also single out the highest-billed claims -- continuous positive airway pressure (CPAP) devices,oxygen equipment, glucose monitors and test strips, and power wheelchairs--which are the most lucrative items for suppliers and thus, at the greatest risk of fraud," Taylor said. "The plan toughens background checks on new suppliers and increases scrutiny on the highest ordering physicians and thehighest utilizing beneficiaries." The Government Accountability Office also highlighted fraud in the sector. "Our review of enrollment of Medicare's durable medical equipment suppliers found weaknesses in Medicare's screening process that exposed the program to potentially paying millions of dollars for medical equipment and supplies that were not necessary or were not provided to beneficiaries," the GAO said in its testimony. The American Association for Homecare proposed its own 13-step plan to fight fraud in the program. "Unfortunately, the 'competitive' bidding program was discussed as if it were an anti-fraud tool and a panacea for Medicare reform," the trade group says in a message to members. • Don't let your referring physicians slide by with stamped signatures on plans of care and verbal orders, or you could pay the price in denied Medicare claims. "Stamped signatures are not acceptable on any medical record," says regional home health intermediary Cahaba GBA, whose reviewers have seen an increase in the banned documentation. "Medicare will accept hand written, electronic signatures or facsimiles of original written or electronic signatures," Cahaba says in its May newsletter. CMS unveiled the stamped signature ban in 2007 and refined its guidance on the matter last year. • Florida's legislature is considering approving a competitive bidding program for incontinence products,AAHomecare notes. "Similar proposals have been debated in Indiana and Ohio regarding bidding programs for incontinence supplies in Medicaid," the trade group adds. "Selective contracting will limit a patient's choice of supplier, limit the range of products available to patients, and add to the complexity and confusion in receiving health care services since beneficiaries are likely to require the services of multiple health care suppliers," AAHomecare says. The newly formed state trade group Florida Alliance of Home Care Services is lobbying against the program. • Don't forget to respond to record requests from your Comprehensive Error Rate Testing (CERT) contractor, urges RHHI National Government Services. But just responding isn't enough. Make sure the records are legible and include records for all dates of service on the claim, the intermediary reminds home care providers on its Web site. "Please ensure that the medical records submitted provide proof that the service(s) was ordered by the MD and rendered," NGS adds. "Also provide justification to support the medical necessity." • The Joint Commission has allowed for more exemptions to its unannounced survey policy and has extended the advance notice timeframe.Home care providers that qualify for an exemption will now receive seven days' notice instead of five, says the accrediting body (formerly JCAHO). The Oakbrook Terrace, Ill.-based organization has added "small, non-deemed health and hospice organizations, if not part of a hospital" and "small home care organizations that provide only one service" to its exemption list. "We found that unannounced surveys can disrupt the delivery of patient care in very small home care organizations," Debra Zak, former executive director of the Commission's Home Care Accreditation Program, says on the accrediting body's Web site. • After some stalling from the opposition,the Senate confirmed former Kansas Gov. Kathleen Sebelius as HHS Secretary April 28. President Barack Obama swore her in that night, citing the pressing need of swine flu preparations. The Senate is sitting on a large backlog of unconfirmed nominees for HHS positions including deputy secretary and the head of the Food and Drug Administration, so timing of an appointment for a CMS Administrator is unclear. • Fans of negative pressure wound therapy have more ammunition on their side. Multiple studies presented at the 22nd Symposium on Advanced Wound Care/Wound Healing Society Meeting in Dallas support the therapy,notes V.A.C. Therapy device maker Kinetic Concepts Inc. in a release. One of the studies compares NPWT versus advanced moist wound therapy. During the active treatment phase, patients treated with V.A.C. therapy had fewer hospital admissions and amputations, aBoston University School of Medicine researcher says in the study. • Amedisys Inc. continues its positive earnings streak. The national chain reported net income of $27.0 million on revenues of $341.8 million for the quarter ended March 31. That compares to a $16.4 million profit on $213.1 million in revenues for the same period in 2008, the Baton Rouge,La.-based company says in a release.
Home Health & Hospice Week
- Prospective Payment System:
GET READY FOR NEW SUPPLIES EDIT IN OCTOBER
CMS puts limits on how you can change NRS digit on final claims. A new [...] - Hospice:
HOSPICE CUT WILL TAKE TOLL ON PROVIDERS, SERVICES
Small, rural providers to be hit hardest. Hospices should brace for Medicare reimbursement cuts ahead -- [...] - Reimbursement:
CMS FINALIZES ADDITIONAL HOSPICE CLAIMS DATA REPORTING MANDATE
Get the details on the new requirement that hits hospices Jan. 1. Hospices will be [...] - Fraud & Abuse:
OIG BLASTS FRAUDULENT S. FLORIDA INHALATION DRUG CLAIMS
Medicare paid five times more for two brand-name inhalation meds in Miami. Billing for budesonide [...] - Therapy:
DON'T OVERLOOK CAREGIVERSWHEN PREVENTING NURSING HOME PLACEMENT
OT helps patients stay at home. It's no news that occupational therapy can benefit older [...] - Industry Notes:
ANOTHER FRAUD CONTRACTOR MAKES DEBUT
CMS names third ZPIC. Medicare is nearly halfway done naming its new fraud-fighting contractors. The [...]
