Advanced Search

Home Health & Hospice Week

Industry Notes:

CERT Slip Will Bring You

Published on Thu Apr 15, 2004

Don't let a non-response mar your record.

If you fail to respond quickly to a record request from a CERT contractor, don't be surprised if you are almost immediately harassed.
 
The Centers for Medicare & Medicaid Services wants its payment error rate information, and it's not kidding around. CMS took over the Medicare payment error rate report from the HHS Office of Inspector General last year, and got a lower response rate to medical record requests than the OIG had been getting (see Eli's HCW, Vol. XII, No. 43, p. 341).
 
Then, when CMS excluded the so-called "non-responders," from its error rate figures, lawmakers harshly criticized the tactics and resulting low error rate. This year, CMS appears to be set on getting those records to complete its error rate report due in November for calendar year 2003.
 
The contractors computing the Comprehensive Error Rate Testing already send out letters on behalf of the OIG when providers fail to respond to a medical record request.
 
Now CMS is requiring carriers and intermediaries to contact "tardy" providers as soon as 20 days after the CERT contractor's initial request. By 30 days after the CERT request, carriers and intermediaries must contact non-responding providers, says CMS Trans-mittal No. 67 dated April 2.

 "We believe that having [contractors] contact non-responding providers will help lower the error rate significantly," CMS says in the One-Time Notice. CMS encourages carriers and intermediaries to use phone calls rather than letters or faxes, but doesn't require it.
 
Contractors may contact "third-party provid-ers" to send in relevant records, but don't have to, CMS adds in the transmittal.
 
If the CERT contractor hasn't received the requested record by 10 days after the contact, the carrier or intermediary will refer the "recalcitrant" provider to regional OIG staff, the transmittal says. What the OIG will do with the information is unclear.
 
What is clear is that before providers have a chance to catch their breath and understand the CERT record request, they could rack up an OIG referral, critics charge.
 
And CMS and its contractors have done a poor job of explaining to providers why CERT records are needed, who the contractors are and that the requests are legitimate, critics add. And now providers are being punished for that incompetence, they claim.

 

  • Regional home health intermediary Pal-metto GBA will implement its new local coverage decision (LCD) on Hospice Alzheimer's Disease and Related Disorders April 28, but it has made a compromise. After receiving comments on the LCD, Palmetto has changed the level of activity limitation supporting the six-month prognosis from Functional Assessment Staging Scale level 7c to FAST stage 7 and above, Palmetto says in a posting to its Web site.
     
    The RHHI didn't include any other dementias in the LCD because it wanted to increase awareness "of Alzheimer's Disease as a terminal condition, thereby adding to the health care options available to Medicare beneficiaries with Alzheimer's Disease," it says.
     
    LCDs have replaced local medical review policies (LMRPs).

     

  • If you were caught in a reimbursement loop due to a claim rejected with reason code C7080, it's now time to resubmit, says RHHI Cahaba GBA. Since December, claims that had been rejecting with the code indicating an overlapping inpatient stay were still being posted to the common working file, and thus blocking any corrections.
     
    Cahaba corrected the error and cancelled the erroneous posted episodes, it says in its April bulletin to providers. Since April 1 home health agencies have been able to submit the corrected requests for anticipated payment (RAPs) and final claims.

     

  • HHAs should beware RAPs and final claims arriving on the same day, warns RHHI Associated Hospital Service of Maine. If AHS receives a final claim before or on the same day as a RAP for the episode, providers may encounter a 764a error, the RHHI says. "Once the RAP has been posted to history with a payment, providers will need to store the final claim that is editing in suspense so that it may continue through the system to adjudication," AHS advises in an April 7 posting to its Web site.

     

  • This month may be the perfect time to give your occupational therapists a pat on the back - April is occupational therapy month.
     
    To kick-off OT month, the American Occupational Therapy Association launched a new Web site,     www.promoteot.org. The Web site contains information about occupational therapy for the public, health professionals and educators.

     

  • Housecall Medical Resources Inc. has shed its respiratory therapy, home medical equipment and infusion businesses to focus on its "core businesses" of home health nursing and hospice, the Knoxville, TN-based company says.
     
    RT giant Apria Healthcare Group Inc. closed the purchase of assets of the Housecall locations in Tennessee and Florida March 31, but didn't assume their liabilities, Housecall notes.
     
    Housecall plans to continue its growth through expansion of existing locations and strategic acquisitions, says the company that operates 67 agencies in Tennessee, Kentucky, Idaho, Virginia and Florida.

     
  • A Pennsylvania HME general manager is going back to work after getting off light in a theft case. Keystone Medical Equipment's Eric Doyle wasn't stealing from his employer - he allegedly was stealing HME items from the competition (see Eli's HCW, Vol. XII, No. 38, p. 304).
     
    A Carbon County judge placed Doyle in a probation-without-a-verdict program for a year after he was charged with receiving $20,000 in stolen property and switching oxygen tank labels, reports the Allentown, PA Morning Call. Much of the property belonged to Keystone competitor Apria, prosecutors said.
     
    Jim Thorpe, PA-based Keystone owner John Joyce fired Christopher Plebani, the employee who blew the whistle on Doyle's activities, the paper says. Joyce cited the reason for the firing as slow business after a Sept. 24 law enforcement raid in the case.

     

  • Honolulu-based Wilson In-Home, a private duty agency, has seen a 168 percent increase in revenues in the past two years, ranking it 12th on the Pacific Business News' 50 fastest-growing companies in 2003. In-Home business manager Shelley Wilson attributes the growth to sustained quality of care and word of mouth, the News reports. The company employs 115 people, 90 percent of whom are female.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All