Home Health & Hospice Week

Suppliers waiting on pins and needles for the onset of competitive bidding now have a firm deadline for the program.

The Centers for Medicare & Medicaid Services will begin accepting bids for durable medical equipment in nine metro areas starting Oct. 21, CMS's Competitive Bidding Implementation Contractor (CBIC) says on its Web site.

The bid window will be open for 60 days and CMS will announce the bid rates and begin contracting with suppliers in June of next year, the CBIC says. The program will go into effect in January 2011.

Start next week: Suppliers can begin signing up for bid system user IDs and passwords Aug. 17, CMS estimates. There are a few changes from the original Round One bid, CMS notes in a release. Puerto Rico will now be excluded from the bid areas and negative pressure wound therapy items and Group 3 complex rehabilitative power wheelchairs will be excluded from the list of bid items. Otherwise the bid areas and items remain the same.

More bidding information, including the detailed timeline and entire slate of educational sessions and materials, is at www.dmecompetitivebid.com.

• Overall health care reform may be one step closer to resolution, but its impact on home care isn't looking any more positive. Before adjourning for August recess, the House Energy & Commerce Committee agreed with the other two House committees with Medicare jurisdiction and approved $57 billion in cuts to home health agencies, notes the National Association for Home Care & Hospice.

The Committee also included a provision that calls for a 0.5 percent cut to the consumer price index-urban (CPI-U) rate update for durable medical equipment for 2010 to 2013, adds the American Association for Homecare.

Energy & Commerce is set to consider more amendments to the reform bill when it returns in September. One is an amendment reducing the HHA cuts by more than $20 billion and redirecting them, NAHC reports. HHA spending accounts for 4.5 percent of Medicare outlays but is scheduled for 11.4 percent of the cuts, advocates are telling lawmakers. Another amendment up for consideration is the so-called Ross oxygen amendment (H.R. 3220).

That legislation has been a lightning rod for the industry, with larger providers and AAHomecare supporting it and smaller providers and the National Association for Independent Medical Equipment Suppliers opposing it.

Meanwhile, bipartisan reform talks between senior Senate Finance Committee members now aren't expected to produce a bill for markup before the Senate adjourns for its August recess. When senators return in September, Committee Democrats and Senate leadership may abandon the talks and come up with their own partisan proposal instead, insiders suggest.

Both houses of Congress will reconvene after Labor Day on Sept. 8.

• You may gain access to more translated Medicare documents if CMS heeds the Government Accountability Office's advice.

"To improve the consistency and transparency  of CMS's translation decisions, we recommend that CMS develop a written, agency-wide policy that includes criteria for the translation of written documents as part of its [Limited English Proficiency] plan," the GAO says in a new report. CMS had translated into Spanish 87 percent of 134 Medicare documents the GAO reviewed, according to the report. Few documents were translated into other languages, however.

Providers said translating documents themselves was difficult due to the high cost and the inability to find qualified translators and interpreters, the GAO notes.

"Medical professionals, including many smaller practitioners, are translating Medicare documents themselves or hiring costly translation services, creating inconsistent information for patients and raising troubling questions regarding privacy rights," says House Small Business Committee Chair Nydia Velázquez (D-N.Y.) in a release.

"CMS needs to accelerate its development of an agency-wide translation policy for Medicare forms to fix the disparities for these vulnerable populations," says Velázquez, who requested the report from the GAO.

The report is online at www.gao.gov/new.items/d09752r.pdf.

• If you submit claims with diagnosis code

V15.88, you should add more details on the claim to avoid hold-ups.

When regional home health intermediary Cahaba GBA receives claims with a trauma diagnosis code like V15.88 (Personal history of fall), it must research the claim to make sure another payor isn't liable under auto, liability, or workers' comp insurance, the intermediary explains in its August newsletter for providers.

Do this: "When submitting a claim with the V15.88 diagnosis code, include a note in the 'Remarks' field (FISS Page 04) acknowledging whether the services are related to a new injury and, if so, where the injury took place," Cahaba instructs. Cahaba lists 10 place of occurrence diagnosis codes, ranging from E849.0 (Home) to E849.9 (Unspecified place), to identify where the injury took place. If no other insurer is liable, include a note in the "Remarks" field to explain why, Cahaba suggests. For example, state that the patient fell on a certain date in the home and no other insurer was liable. Or indicate the patient is at risk for falls, but no fall occurred.

Tip: "Keep in mind that including information in the 'Remarks' field is always helpful in processing your Medicare claims," the RHHI reminds providers. "In addition, Cahaba encourages providers to review the 'Remarks' page when claims are in RTP as there may be instructions from our staff to assist in the successful adjudication of your Medicare claims." To see the article including the full list of place of occurrence diagnosis codes, go to www.cahabagba.com/rhhi/news/newsletter/200908_rhhi.pdf.

• You don't have to worry about Red Flags Rule enforcement just yet. The Federal Trade Commission has granted another threemonth reprieve on enforcement of the rule until Nov. 1, it says in a release.

And when the enforcement deadline does hit, home care providers should be classed with other low-risk entities for Red Flags Rule purposes, the FTC says in new guidance. "Commission staff would be unlikely to recommend bringing a law enforcement action if entities ... perform services in or around their customers' homes," a new frequently asked question about enforcement says.

The FAQ is in E.3 at www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm.

• Medicare's Fraud Strike Forces continue to focus on home care providers. In its latest sweep, 32 people have been indicted on fraud charges related to so-called "arthritis kits," power wheelchairs, and enteral nutrition products, according to a release from the Federal Bureau of Investigation.Authorities made arrests in Houston, New York, Boston, and Louisiana as part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Departments of Justice and Health and Human Services (see Eli's HCW, Vol. XVIII, No. 20, p. 155).

The defendants provided medically unnecessary items or no items at all, the FBI says. "We will protect the Medicare program and its beneficiaries by stopping those who falsely bill for power wheelchairs, orthotic devices and other supplies that are not needed," HHS Inspector General Daniel Levinson says in the release. "Today's arrests demonstrate the significant impact of the new HEAT strike force on combating fraud and abuse in the Houston area."

Houston is the fourth area to be assigned a  strike force, after Miami, Los Angeles, and Detroit, the FBI notes. So far, the strike force campaign has obtained indictments of more than 293 individuals and organizations that have billed the Medicare program for more than $674 million.

The most recent busts were covered widely in newspapers throughout the nation.

• Even if you just downloaded new home health PPS software, you have another new version to download. CMS made a new grouper available July 16, noted CMS's Randy Throndset in the July 29 Open Door Forum for home care providers. But now an even newer one is available.

"It's really important that folks go out and get this new version," which contains some tweaks, Throndset urged listeners.

• Home care companies' earnings reports continue to look rosy. Atlanta, Ga.-based Gentiva Health Services Inc. saw its revenues fall due to the sale of its managed care CareCentrix business last year. Revenues went from $344.2 million for the quarter ended June 29, 2008 to $298.1 million for the quarter ended June 28, 2009. But Gentiva's net income rose from $12.0 million in the year-ago quarter to $17.1 million in the most recent quarter.

Regional chain LHC Group Inc. saw both its profits and revenues rise. The Lafayette, La.-based company reported net income of $14.2 million on revenues of $132.6 million for the quarter ended June 30, compared to an $8.6 million profit on revenues of $90.1 million for the same period last year.

LHC also announced acquisitions in the Certificate of Need (CON) states of Washington and Alabama. LHC is partnering with Northeast Washington Health Programs Association to provide home health services in Chewelah, Wash. And the company is entering into a joint venture with Coosa Valley Medical Center to provide home health services in Sylacauga, Ala. and the surrounding area, LHC says in a release. The acquired agencies have annual net revenues of $2.5 million and $1.1 million, respectively.

LHC also touted its days sales outstanding (DSO) figure, which it cut from 60 days in the yearago quarter to 45 days in the most recent quarter.

• Hospice chain Odyssey Healthcare Inc. has seen its profits spike in the latest quarter. The Dallas-based for-profit company reports net income of $8.6 million on revenues of $170.3 million for the quarter ended June 30. That compares to a $1.7 million profit on $160.7 in revenues for the same period in 2008.

Odyssey has improved its Medicare cap standing via "changes in patient mix and increased admissions in some of our cap markets," CEO Robert Lefton says in a release.

• You've got a new sheriff in town for HIPAA enforcement. The Department of Health and Human Services is handing over the administration and enforcement of the Security Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to the HHS Office for Civil Rights.

CMS formerly oversaw enforcement of the rule. The Security Rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic-protected health information.

• Your patients and their caregivers may find a new Medicare resource useful. Ask Medicare, the e-newsletter for caregivers, is gaining a lot of positive feedback. The Web site helps beneficiaries' caregivers make sense of the ins and outs of the Medicare system and is part of CMS's "My Health. My Medicare" campaign.

Through this campaign, CMS says, it can help people with Medicare understand and evaluate their health and prescription drug coverage and motivate them to take advantage of all Medicare has to offer.

The site is online at www.cms.hhs.gov/MyHealthMyMedicare/10_AskMedicare.asp.