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 ulcers saw no instance of emergent care due to wound infection or deteriorating wound status, San Antonio-based KCI says in a release. In contrast, patients not receiving V.A.C. therapy had a 7 percent rate. For Stage IV pressure ulcers, the emergent care figures were 0 percent for V.A.C. patients and 11 percent for non-V.A.C. patients.

Hospitalization statistics were equally dramatic. V.A.C. patients with Stage III pressure ulcers had a 3 percent instance of hospitalizations due to wound infection or deteriorating wound status, versus 11 percent for non-V.A.C. patients. For Stage IV ulcers, V.A.C. patients saw a 6 percent rate versus 20 percent for non-V.A.C. patients, KCI says.

• A Missouri home care provider has won a fresh look at an unfavorable court case involving non-compete agreements for employees. When the Missouri Court of Appeals, Southern District ruled against Oxford Healthcare in a non-compete case, the home health agency requested a transfer to the state's highest court (see Eli's HCW, Vol. XIV, No. 29).

Now the Missouri Supreme Court has agreed to hear the case, reports Oxford's attorney, Rick Temple based in Springfield, MO. But observers shouldn't draw any inferences about the merits of the case, since the Supreme Court doesn't provide any reasons for granting the application, Temple tells Eli. Filings are due in the case in the next few months, after which the court will schedule oral arguments, Temple explains.

• A federal appeals court has rejected a qui tam case accusing three major DME companies of Medicare fraud.

Kirk Corsello, a former employee of Lincare Holdings Inc. and Rotech Healthcare Inc., alleged that those companies as well as American Home-Patient Inc. violated the False Claims Act by engaging in a pattern of improper practices that led to the submission of fraudulent Medicare claims. However, a federal district court ruled--and the 11th U.S. Circuit Court of Appeals affirmed--that Corsello failed to detail specific fraudulent claims in his case, initially brought in 1998.

"Because it is the submission of a fraudulent claim that gives rise to liability under the False Claims Act, that submission must be pleaded with particularity and not inferred from the circumstance," the appeals court said in its ruling. The Oct. 20 decision is at http://caselaw.lp.findlaw.com/data2/circs/11th/0511868p.pdf.

• Amedisys Inc.'s earnings skyrocketed in the quarter ended Sept. 30. Thanks in part to some major acquisitions, including the purchase of 66-location Housecall Medical Resources Inc., the regional chain's net income shot up 50 percent and revenues increased 92 percent compared to the year-ago quarter.

Amedisys reported net income of $7.8 million on revenues of $112.2 million for the quarter. The figures include the impact of Hurricane Katrina, estimated at between 0.02 cents to 0.03 cents per share, the Baton Rouge, LA-based company says.

• Apria Healthcare has taken down its for-sale sign. The Lake Forest, CA-based provider of home health products and services announced recently that it would focus on revenue growth and operating improvements rather than looking for a buyer.

The company recently announced a drop in third-quarter net income to $19.3 million on revenues of $367.6 million. That compares to net income of $29.8 million on revenues of $364.6 million in the previous year's third quarter. Apria blamed the drop on Medicare cuts for certain DME and respiratory medications.

• Hurricanes Katrina and Rita contributed to Odyssey HealthCare Inc.'s woes in the latest quarter. The Dallas-based for-profit hospice chain reports net income of $7.7 million for the quarter ended Sept. 30, down 14 percent from the $9.0 million profit for the same period in 2004. But revenues increased during the same period, up 13 percent to $98.9 million.

Katrina and Rita disrupted four Gulf Coast locations, resulting in a patient census drop of about 290, the company says.
 
And Odyssey's Medicare cap exposure was $2.1 million higher than expected, due to CMS' hospice cap calculation errors revealed in August (see Eli's HCW, Vol. XIV, No. 31).