Home Health & Hospice Week

You're responsible for obtaining referring physicians' numbers, feds remind.

Don't be surprised to see claims rejections if you're not geared up for the National Provider Identifier requirements that hit May 23.

"As of May 23, Medicare FFS will require and send NPI-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required," the Centers for Medicare & Medicaid Services warned on the eve of the deadline. "If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected," CMS told providers.

And providers aren't off the hook for furnishing referring physicians' NPIs just because there's a backup plan. If the doc "does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim," CMS reminds providers. Providers can use the NPI registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do or contact the physician directly for the number.

Last resort: To use its own NPI in the secondary field, a provider must have "exhausted all possibilities of finding the NPI" of the referring or prescribing physician, CMS directs.

If all your efforts are for naught, don't leave the secondary field blank, the agency warns. "Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present," it says. It's OK to use your own NPI in the field if you've made a good faith effort to find the doc's NPI first. More information on NPIs is at www.cms.hhs.gov/NationalProvIdentStand.

• Congress' budget resolution for 2009 is looking like it won't contain any Medicare or Medicaid cuts but providers are still vulnerable to rate reductions that will take place in 2008.

House and Senate Democratic leaders have nearly come to an agreement on a 2009 budget blueprint that rejects President Bush's proposed spending reductions for Medicare and Medicaid, according to press reports. The resolution isn't binding and will guide budget negotiations later this session.

But the package that will head off physicians' 10 percent cut to Medicare rates set to take effect July 1 could be much more threatening to home care providers. Lawmakers are still looking for ways to fund the physician fix, and home health agencies, hospices and durable medical equipment suppliers are all on the short-list for rate reductions.

• Your patients on oxygen may have an easier time traveling by air, thanks to a new rule from the Department of Transportation. The DOT now requires airlines to allow all passengers needing portable oxygen access to aircraft. "Prior to the new ruling, portable oxygen containers were designated as a permissible carry-on item, but airlines were still permitted to deny passengers carrying these containers," notes a release from Sens. Mike Crapo (R-ID) and Blanche Lincoln (D-AR).

The rule "is big win for patients who use supplemental oxygen," David Ingbar, President of the American Thoracic Society, says in the release.

• CMS' newly created fraud edit modules will be available to DME contractors in the fall. CMS described the creation of the fraud modules, which allow Medicare contractors to share fraud-fighting edits and other practices, in a March transmittal (see Eli's HCW, Vol. XVII, No. 11).

Now a new May 16 transmittal makes "fraud edit capabilities... available to the VIPS Medicare System (VMS) users" starting Oct. 1, says transmittal No. 342 (CR 6035). All four DME MACs use VIPs to manage and process DMEPOS claims, VIPs vendor VIPs Inc. notes on its Web site.

Fraud module sharing arose after infusion therapy fraud in South Florida spread to other states, the transmittal notes.

• Keeping patients in their homes helps their mental health, according to a new study by social work students at Indiana State University. The study of 272 people with an average age of 81 found that the "elderly in a long-term care setting are more likely to be prescribed antidepressants and to self-report depression compared to those in a home-health care setting," according to a release.

The study looked at one long-term care facility and one HHA in west-central Indiana. "At the long-term care facility, 30 percent of the elders in the study reported feeling depressed, compared with 11 percent who received care in their homes," says the ISU release.

"When an individual moves to a long-term care facility, they undergo a tremendous amount of changes," says researcher Lindsay Egan. "They are no longer able to live independently and are relying on others for care, and this greatly affects how they feel about themselves and the world around them."

Egan and co-researcher Jodi Shapuras won first place in ISU's 12th annual Undergraduate and Graduate Research Showcase for their study, "Comparison of Depression in Elders Who Receive Home Health Care to Elders Residing in a Long-Term Care Facility."

• The Joint Commission has awarded its first Chronic Obstructive Pulmonary Disease (COPD) certification, the Oakbrook Terrace, IL-based accrediting body says in a release. Easy Breathing Clinic in Augusta, ME received the certification, says the former Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

• DMEPOS billers should transition to the Common Electronic Data Interchange (CEDI) by June 1, says new CEDI contractor National Government Services.

Under NGS' new contract, "CEDI will provide a single front end solution for the submission and retrieval of electronic transactions for the DME MACs," the contractor says.

DMEPOS claims and claims status inquiries will all go to CEDI and electronic remittance advices (ERAs) and 277 Claims Status Response transactions will all come from CEDI, NGS notes.

Resource: More CEDI information is online at www.ngscedi.com.

• It's not just competitive bidding that's hitting small Medicare providers hard. On May 14, a representative from the Texas Association for Home Care testified before the House Small Business Subcommittee on Regulations, Health Care and Trade.

TAHC President Mary Helen Tieken outlined a laundry list of CMS regulations and policies that burden small providers, ranging from directly provided service requirements to PPS claims processing holdups, according to the National Association for Home Care & Hospice.

• Providers served by NGS may see their electronic remittance advice problems get worse before they get better. After the transition to HIGLAS, providers received separate ERAs based on OSCAR and NPI numbers for the same transaction.

A fix for that problem installed May 4 seems to have caused "missing SE, GE, and IEA segments at the end of their remittance files," NGS reports in a message to providers. NGS is testing a solution for that problem, it says.

• The multi-agency fraud "strike force" that has secured more than a hundred Medicare billing fraud-related convictions in South Florida has set its sights on Southern California. The campaign is targeting fraudulent billing for DME and infusion, according to a release from the Department of Justice's Criminal Division.

On May 8, federal agents arrested 10 people in California for fraudulent billing of "wheelchairs, orthotics and other DME that was medically unnecessary and/or not provided to the beneficiaries identified in claims," the DOJ says. "All defendants arrested today were owners and operators of medical supply companies in the Los Angeles area."

DME suppliers singled out in the release include David Gabrielyan and Marina Nazarova, owners of U.S. Medtrade Co. Inc.; Jesus Zamarripa, owner of Edward Medical Supply Inc.; and Usik Kirakosian and Petros Odachyan.

Both the Miami and L.A. "phases of the strike force have seen high levels of DME fraud," the DOJ maintains.

• Good communication with your patients is key, unless you want to risk ending up on the Senior Medicare Patrol hit list.

The volunteer group of seniors trained in detecting and reporting Medicare fraud and abuse ended up heading off nearly $7.5 million in improper Medicare payments and recovered another $300,000 in already spent Medicare funds, according to a new HHS Office of Inspector General report, "Performance Data for the Senior Medicare Patrol Projects: April 2008 Performance Report" (OEI-02-08-00120).

Example: In one case alone, an inquiry submitted to the Patrol led to 13 providers having their Medicare numbers revoked for billing services never rendered, the OIG reports. That resulted in a savings of a $7.3 million, the report says.

In 2007, the 57 projects trained a total of 10,338 active volunteers.  These volunteers educated beneficiaries in 6,587 group education sessions and held 131,359 one-on-one counseling sessions.

The Patrol program probably doesn't receive full credit for its Medicare savings because some beneficiaries educated by Patrol volunteers call the OIG hotline directly, the report notes.

The report is online at www.oig.hhs.gov/oei/reports/oei-02-08-00120.pdf.