Home Health & Hospice Week

Providers are doing a pretty good job of billing with their own NPIs, but not so well for their referring physicians.

Most Medicare contractors report that more than 90 percent of claims are National Provider Identifier-compliant, the Centers for Medicare & Medicaid Services says.

But there are still NPI problems, and many of them involve the lack of an NPI in the secondary provider field, which is usually the referring physician's NPI for home care providers' claims. "We are seeing this particular issue rapidly improve as more and more providers realize the need for NPI-only in secondary identifier fields," CMS says.

Not all the NPI problems are providers' fault. Reason codes 32152 and 32159 were inappropriately applied to the secondary provider identifier due to issues with the physician file, reports the National Association for Home Care & Hospice.

But those issues have been resolved, says regional home health intermediary Cahaba GBA.

• There's a new prospective payment system billing snafu to watch out for. "The clinical domain is inexplicably, and incorrectly, being downcoded on final claims when more therapy services are delivered and billed than projected on the request for anticipated payment (RAP)," NAHC reports.

This alleged error joins other existing problems such as the claims system's inability to count 2007 episodes when determining early or later episode sequence based on M0110.

• Don't forget to use the new 855 enrollment form starting July 1, RHHI Cahaba GBA reminds providers. "Effective July 1, 2008, Cahaba will no longer accept applications on the old 2006 version of the CMS-855," the intermediary warns in a message to providers. More providers than ever before are using the 855 forms due to new reenrollment rules, fraud demonstration requirements and paperwork necessary for the PECOS transition (see Eli's HCW, Vol. XVII, No. 17).

• CMS wants hospices to plan and budget for 2008, so it has released the hospice per beneficiary cap amount for the year: $22,386.15.

CMS has also furnished its methodology for computing the cap so that providers can do so for themselves for future years. Details are at www.cms.hhs.gov/hospice/downloads/2008_Aggregate_Cap_Amount.pdf.

Hospice payments in excess of the caps were a topic of concern for the Medicare Payment Advisory Commission in discussing hospice payment reform this year (see Eli's HCW, Vol. XVII, No.11). CMS will issue a formal notice of the cap this summer, it says.

• Home care providers furnishing Part B therapy will have to abide by the Part B therapy caps for all patients unless lawmakers intervene.

"On or after July 1, 2008, the exceptions to therapy caps are restricted to those medically necessary services billed by the outpatient departments of hospitals," Palmetto says on its Web site. "Use of the KX modifier will not be effective on or after July 1."

For 2008, the caps are $1,810 for combined physical therapy and speech-language pathology services; and $1,810 for occupational therapy services. The caps don't apply to therapy furnished under a Part A home health plan of care.

Ray of hope: Part B exceptions may get extended if provisions in a bill proposed by Senate Finance Committee Chair Max Baucus (D-MT) become law.

• Your patients may be able to receive a little more help in figuring out which Part D plan for drugs to enroll in this year. CMS will give an additional $15 million to State Health Insurance Assist-ance Programs (SHIPs) to educate benes about their insurance options. CMS is giving SHIPs a total of $50 million in 2008 for Medicare insurance counseling, CMS says in a release.

• Home care chains are hard on the acquisition trail these days. Gentiva Health Care Services Inc., Amedisys Inc. and LHC Group Inc. all recently announced new purchases.

Melville, NY-based Gentiva has acquired Colorado's Physicians Home Health Care for $12 million in cash, the national chain says. The acquisition of PHHC, which has $9.4 million in annual revenue, marks Gentiva's entry into its 38th state.

Baton Rouge, LA-based Amedisys has bought five home health locations from Health Management Associates Inc. for undisclosed terms. The locations are in Mississippi and South Carolina--both certificate of need states--and Missouri, the national chain says in a release.

The acquisitions will generate about $4 million in annual revenue initially, Amedisys expects.

And LHC has entered into two joint ventures in Arkansas. The Lafayette, LA-based company is partnering with Jefferson Regional Medical Center in Pine Bluff and Community Medical Center of Izard County in Calico Rock to offer home care and hospice services.

Annual revenue for both agencies combined is about $3 million, LHC says in a release.

• It's not just your imagination that Florida providers are racking up Medicare fraud charges. Twenty percent of all federal Medicare fraud prosecutions are filed in South Florida, according to the South Florida SunSentinel.

A Medicare fraud strike force established last year in Miami has brought 120 criminal and civil cases against more than 200 defendants in South Florida who have been charged with more than $638 million in fraud, notes the Miami Herald.

For example: In the latest case, four individuals were charged in an alleged $5.4 million DME-related scam, according to a release from U.S. Attorney R. Alexander Acosta. Medicare paid Hia-leah-based Med-Pro of Miami Inc. $1.3 million for bogus DME claims, Acosta says.

The DME items billed were neither prescribed by doctors nor delivered to Medicare patients, most of whom resided in the Fort Pierce area, the release says. The investigation began when beneficiaries complained about the fraudulent billing for medical equipment.