Home Health & Hospice Week

Rehab code acceptable only as primary diagnosis, new guidelines say.

If you're still reporting V57.x as a secondary diagnosis, you could be jeopardizing your therapy claims.

As of Dec. 1, coding guidelines advise that V57.x (Care involving use of rehabilitation procedures) has been added to the list of V codes which are only acceptable as principal or first-listed diagnoses.

"This means that if therapy is the primary reason for home health, then V57.x would be coded first. Otherwise, you wouldn't code it," says consultant Lisa Selman-Holman with Selman-Holman & Associates in Denton, TX. If you are providing more than one therapy, you may report V57.89 (Multiple training or therapy) in M0230, she advises.

The new coding guidelines are at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide05.pdf.

For more information, see Eli's Home Health ICD-9 Alert, available at www.elihealthcare.com or by calling 1-800-874-9180.

• If the Comprehensive Error Rate Testing auditor didn't do a good job of following up with you about its documentation requests, then you're not alone.

CERT contractor AdvanceMed didn't always follow up via phone if you failed to send in medical records after the first request, complains the HHS Office of Inspector General in a recent report on the CERT program. But AdvanceMed did a better job of completing quality assurance reviews properly than it did the last time the OIG scrutinized its practices.

The Centers for Medicare & Medicaid Services could be doing better at making sure that the CERT program is consistent, the OIG adds in its report  (A-03-05-00006). The OIG recommended that CMS centralize the management of the CERT program and make sure the sampling periods for CERT audits are the same every time.

• One more home health agency has seen its favorable Provider Reimbursement Review Board decision on therapist compensation reversed by the CMS Administrator.
 
CMS has overturned Colorado Home Care Inc.'s September PRRB decision, where the Board disallowed application of salary equivalency guidelines for outside therapists to directly employed therapists' compensation (see Eli's HCW, Vol. XIV, No. 35).

"Contrary to the Board's finding that the employment relationship between the Provider and the physical therapists determined whether the Guidelines should be applied, the Administrator finds that the fee-for-service compensation of the Provider's therapists was the controlling factor in the application of the limits in this case," the Administrator says in the decision.

When the PRRB issued its decision, Colorado Home Care's attorney said the agency planned to appeal an anticipated CMS reversal.

• The Texas HHA owner and doctor's office manager accused of administering fake flu shots may soon face the music for the alleged misdeeds. Iyad Abu El Hawa, owner of Comfort & Caring Home Health in Houston, and Martha Denise Gonzales were indicted last month on charges that they conspired to inoculate at least 1,100 Exxon Mobil employees at a company health fair with a fake flu vaccine that was actually purified water (see Eli's HCW, Vol. XIV, No. 40).

Gonzales pled not guilty in federal court and her trial is set to start Jan. 9, reports The Houston Chronicle. Gonzales, who could face up to 25 years in prison if convicted, remains free on a $50,000 bond.

• CMS has notified the Region B durable medical equipment regional carrier of a claims processing error. Claims transmitted to the Coordination of Benefits contractor on Nov. 23 were mistakenly processed twice.

All claims were originally crossed over to the correct trading partner, but the COBC processed the same claims a second time, causing duplicate denials.

Suppliers who received a Nov. 28 letter indicating claims were not transmitted to the appropriate trading partner should disregard the letter, DMERC AdminaStar Federal says.

• Pediatric Services of America Inc. saw a rise in earnings in 2005 in the face of some unforeseen challenges. "Despite the disruptions that Hurricanes Katrina and Rita dealt our operations in the fourth quarter, we were able to achieve our full-year earnings guidance," PSAI CEO Daniel J. Kohl says in a release.

The Norcross, GA-based pediatric home care company reported net income of $5.7 million on revenues of $172.2 million for the year ended in September, compared to a $4.0 million profit on $162.6 million in revenues in 2004. During the year, PSAI completed the sale of its pharmacy business to Accredo Health Group Inc. for about $72 million.

• Certification troubles took a bite out of National Home Health Corp.'s profits in the quarter ended Oct. 31.

The Scarsdale, NY-based company reported net income of $1.1 million on revenues of $26.3 million for the quarter, compared to a $1.4 million profit on revenues of $24.2 million in the same period of 2004.

From March 2004 through August 2005, the state conducted "various licensing and certification inspections of the Company's Medicare certified subsidiary in Connecticut," NHHC says in a release. Surveyors accepted a plan of correction for the findings and the resulting consent order remains in effect until fall of 2007, the company says.

• Invacare Corp. has lowered its fourth-quarter earnings guidance. The Elyria, OH-based DME company says it expects a revenue shortfall of $30 million for the quarter. It blamed implementation of a new $20 million enterprise resource planning system, which also resulted in additional overtime and delays in getting products to customers.

• DMERC Region B's loss is Region C's gain. Region B Medical Director Dr. Adrian Oleck is moving to Region C in March. The change comes as CMS prepares to leave behind the DMERC system for the new Medicare Administrative Contractor system.

It's been a time of changes for DMERC medical directors: Last month Dr. Mark Pilley was named medical director for DMERC Region D.

 • Warning: CMS' redesigned Web site at www.cms.hhs.gov may render many of your bookmarks useless. The site is supposed to have improved Google search features, CMS says.