Home Health & Hospice Week

Intermediaries put adjusted claims from the first year of PPS on display.

Now is the time to finally find out your tab for incorrect M0175 answers during the first year of the prospective payment system.

The Centers for Medicare & Medicaid Services directed the regional home health intermediaries to post on Oct. 24 home health agencies' pending adjustments related to the OASIS item on prior inpatient stays (see Eli's HCW, Vol. XIV, No. 36).

But not all RHHIs have been able to live up to the deadline. While United Government Services and Cahaba GBA say on their Web sites that the adjustments are available for viewing, Palmetto GBA at press time hadn't yet posted the M0175 adjustments for fiscal year 2001.

It appears Palmetto will offer a later implementation date for the adjustments in light of CMS' five-week viewing period requirement. "The notification period and the date the adjustments begin will be adjusted accordingly," the intermediary says on its Web site. • RHHI Cahaba GBA isn't letting up on a variety of probes related to diagnosis codes. The intermediary found significant denial rates in probes targeting claims with a primary diagnosis of 331.0 (Alzheimer's Disease), 332.x (Parkinson's Disease), 295.xx (Schizophrenic Disorders), 728.2 (Muscle Wasting and Disuse Atrophy, NEC), 728.9 (Unspecified Disorder of Muscle, Ligament, and Fascia), and 496 (Chronic Air-way Obstruction). Error rates from 35 to 73 percent necessitated a continuation of the probes, Cahaba said.

The intermediary is also continuing a probe of claims with revenue code 042X that meet the 10-visit therapy threshold and a length of stay between 61 and 120 days. A probe conducted from March to June racked up an error rate of 42 percent. Documentation often failed to support the medical necessity of therapy visits billed, Cahaba charged.

More probe information is at www.iamedicare.com/Provider/newsroom/whatsnew/whatsnew.htm. • California durable medical equipment providers who accept Medicaid need to cozy up to rehab specialists. As of July 1, 2006, the state's providers must use a physical therapist, occupational therapist, National Registry of Rehab Technology Suppliers registrant or someone credentialed by the Rehabilitation Engineering & Assistive Technology Society of North America to evaluate patients and deliver custom rehab equipment.

The change comes as a result of legislation backed by the California Association of Medical Product Suppliers and signed into law by Gov. Arnold Schwarzenegger (R). • Negative pressure wound therapy is reducing hospitalization and emergent care needs for home care patients, says a new study released at the National Association for Home Care & Hospice annual meeting in Seattle.

For the study, data firm Outcome Concept Systems Inc. analyzed 1.9 million OASIS start of care assessments, says Kinetic Concepts Inc., which offers NPWT under its V.A.C. product name.

Patients on V.A.C. therapy for Stage III pressure [...]