Home Health & Hospice Week

Be prepared to use both old and new numbers during transition.

The national provider identifier project is off to a slow start.

So far, only about 135,000 providers have registered for an NPI, but the Centers for Medicare & Medicaid Services expects registrations to pick up steam soon, CMS officials told a Sept. 12 town hall meeting for providers.

Even though Medicare will start requiring NPIs on May 23, 2007, small health plans have another year after that to keep using the old numbers. So if you work with some small managed care plans, you may need to use the old numbers a little longer. Medicare will try to work smoothly with Medigap insurers and other insurers that keep using the old numbers for crossover claims, officials said.

CMS won't make the new NPIs available to everyone, so it will be up to individual providers to furnish their new NPI to referral sources and people they work with, officials said.

Information about the NPI process, including how to apply for one, is in a new Medlearn Matters article (SE0555) at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0555.pdf. CMS will soon launch a NPI Medlearn Web page for Medicare providers.

• Medicare has announced the new premiums and deductibles for 2006. The Medicare Part B monthly premium will be $88.50 in 2006, up $10.30 from the current $78.20 premium, CMS says in a release. "Continued rapid growth in the intensity and utilization of Part B services is the primary reason for the premium increase," according to the agency.

The Part A deductible will be $952, up $40 from this year. The Part B deductible will be $124, up from $110 this year. And the Part A premium, which 99 percent of beneficiaries don't have to pay, will be $393 per month, up $18 from this year.

• The Health and Human Services Department has formally approved prescription drug plans (PDPs) and Medicare Advantage plans that will offer coverage under Part D beginning Jan. 1, 2006. Your patients will have a choice of PDPs in every state, and 11 to 20 organizations will offer PDPs in each region. At least one PDP in each state (except for Alaska) offers a premium of less than $20 per month, HHS notes. MA PDPs in 44 states will offer drug plans at no additional cost to beneficiaries.

The start of enrollment is Nov. 15. A map of the PDP and MA plan regions is online at www.cms.hhs.gov/medicarereform/mmaregions/.

 • Durable medical equipment regional carrier AdminaStar Federal Inc. has agreed to pay the federal government $6 million to settle allegations that the DMERC interfered with Medicare evaluations and overcharged the program, the Department of Justice has announced. The settlement follows two whistleblower lawsuits against the Indianapolis-based carrier under the False Claims Act.

From 1991 through 1998, AdminaStar's em-ployees purportedly altered claims information and Medicare files and hung up on customer service phone calls to improve the company's evaluation scores on its Medicare operations administration in Kentucky.

"This settlement reinforces the strong commitment that [CMS] and the federal government have to ensuring that Medicare contractors properly perform their contractual obligations," CMS Administrator Mark McClellan says in a release.

• The federal official who convened the Interagency Wheelchair Working Group has been reassigned over ethical lapses. Dr. Sean Tunis, former chief medical officer for CMS, is now working at the Agency for Healthcare Research & Quality as a biomedical research scientist, the New York Times reports.

In June, Tunis agreed to a one-year suspension of his medical license and a $20,000 fine for falsifying documents related to completion of continuing medical education courses (see Eli's HCW, Vol. XIV, No. 22). In his role at CMS, Tunis helped decide which services and medical devices Medicare would cover.

• New York-based Home Health Care Inc. will buy four home health agencies from bankrupt HealthEssentials Solutions for $16 million, reports the Louisville, KY Courier-Journal. HHCI is a company created by Kinderhook Industries, a New York equity firm. A bankruptcy judge approved the sale Sept. 16.

Specialized Home Healthcare Services of Central Florida Inc., MAJJ Enterprises, Best Choice Home Care Naples, and HealthEssentials Home Care operate in Florida and Nevada. The HealthEssentials parent company faces whistleblower suits for its nurse practitioner business, the paper says. The government is expected to allege more than $30 million in Medicare fraud.

• Oxygen tanks are being blamed for contributing to a bus explosion that killed 23 elderly people fleeing Hurricane Rita.

The bus was carrying 38 residents and six employees of an assisted living facility in Bellaire, TX, according to news reports. The vehicle apparently caught fire due to mechanical problems, and then passengers' portable oxygen tanks began exploding. The National Transportation Safety Board is investigating the incident.

• Mobility stakeholders want to have a word with Congress. The American Association for Homecare, National Coalition for Assistive & Rehab Technology, the ITEM Coalition, Restore Access to Mobility Partnership and United Spinal Association are planning a fly-in to Washington on Oct. 6. The groups will share their concerns about CMS' recent mobility policy announcements with members of Congress and ask for a delay in implementation of the new policies from January to April 2006.