Home Health & Hospice Week

New NPI requirement delays payments.

When you fail to include your zip code on your Medicare claims, expect to take longer to obtain payment.

A National Provider Identifier requirement to include your zip code on all billing transactions took effect Jan. 1, regional home health intermediary Cahaba GBA says on its Web site. For bills including RAPs, "providers must report a five- or nine-digit zip code for their primary facility and its subparts," Cahaba instructs.

Claims without the zip codes will be returned to provider (RTP'd) with reason code 32114, Cahaba notes. Home health agencies served by Palmetto GBA will see the claims held in location SMTECH, the intermediary says on its Web site.

Many providers were unaware of the new requirement, Cahaba says. "A large amount of billing transactions have suspended with reason code 32114."

Oops: That may be because the system applied the edit in error to 2006 claims as well. "The reason code was set to edit on any claim received on or after 1/1/07," RHHI United Government Services says on its Web site. "This was incorrect. It should have been coded to set on claims with service dates on or after 1/1/07" (emphasis added).

"A temporary workaround has been developed," UGS announces. "Providers that have had claims with 2006 service dates returned to them in error should resubmit the claims," the intermediary instructs.

Tip: Report the zip code of your primary facility and its subparts, not your billing facility, Cahaba says.

Another delay: HHAs served by Palmetto may also be seeing another claims hold-up. "Home Health and Hospice claims with service dates 01/01/07 and after will be held in location SMRHHI until the rate changes can be verified," Palmetto says on its site.

• President Bush signed H.R. 6111, the Tax Relief and Health Care Act of 2006, into law Dec. 20. The law leaves the home health, hospice and oxygen payment rates intact, extends the therapy cap exception process, expands the Recovery Audit Contractor program to all states and requires a Medicare Payment Advisory Commission report on wage index (see Eli's HCW, Vol. XV, No. 45).

• RHHIs Associated Hospital Service of Maine and United Government Services and durable medical equipment regional carrier AdminaStar Federal are merging under one parent organization. AHS, UGS and AdminaStar became National Government Services effective Jan. 1, according to releases from the intermediaries. NGS combines the operational, financial and human resources of AHS, UGS, Admina-Star, Anthem Health Plans of New Hampshire and Empire Medicare Services.

NGS will be the Medicare RHHI for: Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, Oregon, Rhode Island, Vermont, Washington and the U.S. Territories of American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and U.S. Virgin Islands.

It will be the DMERC for Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin (and temporarily Virginia and West Virginia).

• The Centers for Medicare & Medicaid Services and the state Quality Improvement Organizations have kicked off their campaign to reduce unnecessary hospitalizations. "The Home Health Quality Improvement National Campaign 2007 is a grassroots collaborative quality improvement effort among the home health community, health care leaders, and Quality Improvement Organizations (QIOs)," according to the campaign's Web site at www.homehealthquality.org. "The goal of the campaign is for home care patients to remain in their home settings, resulting in fewer avoidable hospitalizations."

The campaign will provide participating home health agencies with free tools, resources, guidelines, success stories, best practice education materials and data, the site says. It will electronically distribute monthly "intervention packages" to registered agencies. HHAs can register on the Web site.

In Texas, QIO TMF Health Quality Institute and the Texas Association for Home Care are reaching out to the state's 1,700 agencies to participate, according to a TMF release. "Texas currently has the fifth highest rate of hospitalization for home health patients of the 53 U.S. states and territories," the release says. "If every home health agency in Texas were able to prevent one unnecessary hospitalization per year, more than $13.5 million could be saved annually." That's a 1.6 percent reduction in the number of hospitalizations among Texas home health patients.

Bonus: Participating agencies will receive individual agency reports, TMF says.

• Take note: CMS continues to push preventive services. Its latest offering: an educational video offered through the Medicare Learning Network.

The program, "An Overview of Medicare Preventive Services for Physicians, Providers, Suppli-ers, and Other Health Care Professionals," provides an overview of preventive services covered by Medicare. It also furnishes information on risk factors associated with various preventable diseases and highlights the importance of prevention, detection and early treatment of disease, notes the agency.

To order or get more information, go to www.cms.hhs.gov/MLNGenInfo and scroll down to select the "MLN Product Ordering Page" link.

• You can point patients to a new government Web site that will assist them in planning for their long-term care needs. The Department of Health and Human Services has set up www.longtermcare.gov to help Americans get information they need to plan for their long-term care, according to an HHS release.

The site, mandated by the Deficit Reduction Act, includes information to help consumers decide whether to purchase long-term care insurance or to pursue other private market alternatives that pay for long-term care; information about states with long-term care partnerships under Medicaid; and information about the limitations of coverage for long-term care under Medicaid.

The site also gives users tools like a savings calculator, contact information for a range of programs and services, and real-life examples of how individuals have planned successfully, HHS says.

The site and related Older Americans Act reauthorized by President Bush in October support "improved home and community-based long-term care options ... that allow Americans to remain vibrant and independent," HHS' Assistant Secretary for Aging Josefina Carbonell says in the release.

• Heads up, hospices: you should keep a close eye on claims in medical review to prevent billing delays, according to RHHI Palmetto GBA.

If a hospice claim is suspended in medical review and you bill the subsequent claim for the patient, it will be returned to provider (RTP'd), Palmetto explains on its Web site. After 60 days, any claims still in RTP status will be inactivated and you won't be able to bill successfully any subsequent claims for that patient.

The solution: "To prevent RTP claims, monitor the status of pending claims in Direct Data Entry (DDE) and hold the billing of subsequent claims until the prior claim has fully processed," Palmetto advises.

Tip: "To determine if a claim is fully processed, look for the Status and Location of PB9997 or DB9997 in DDE or call the Provider Contact Center," Palmetto says.

• The Scooter Store is looking for a new leader. Mike Pfister, president of The Scooter Store since 2003, is resigning to become chief information officer for Halliburton, the company has announced.