Home Health & Hospice Week

The feds have made good on a pledge to loosen a punishing new restriction on home health agency changes of ownership (CHOWs) -- but the new rule will still hit many HHAs hard.

In regulations that took effect Jan. 1, the Centers for Medicare & Medicaid Services puts new restrictions on billing for agencies in certain CHOW situations. When an agency has undergone a CHOW in the last 36 months, a second CHOW will trigger a Medicare billing deactivation that the agency can remedy only with a state or deemed accreditation survey, CMS says in Dec. 18, 2009 Transmittal No. 318 (CR 6750). Once the agency successfully completes the survey, it must send the results to its intermediary, which will reinstate the provider's billing privileges, the transmittal says.

Due to a wider than usual definition of a CHOW, the change can wreak major havoc on agencies who simply went through minor stock or ownership partner changes (see Eli's HCW, Vol. XIX, No. 2, p. 10).

At the time, CMS said the new rule would apply to any CHOWs in the pipeline. But now it says in an MLN Matters article addition that it will apply the rule only to CMS-855A applications received after Jan. 1. "Applications received prior to January 1, 2010, will be handled in accordance with the policies in place prior to January 1, 2010," CMS explains in the brief clarification.

The new modification won't make a difference to many agencies, points out consultant William Cuppett in the National Association for Home Care & Hospice newsletter. "The 36-month rule, as it is now being implemented, will cost Medicare providers substantial amounts of money and resources in their attempts to meet organizational objectives that would best serve their patient populations," Cuppett warns. "Future transactions may require the incorporation of management agreements or other arrangements facilitating a transfer of control without a transfer of ownership pending completion of the 36-month period from any previous ownership transfer."

The bottom line: "The current CMS policy position has essentially frozen any changes in ownership, including internal corporate reorganizations, because of the significant risks that exist that Medicare participation may be terminated," NAHC says.

Resource: See the clarification in the updated article online at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6750.pdf.

• Durable medical equipment suppliers are getting a little bit of help from one Medicare contractor about their recent sky-high CERT error rates, but the damage may already be done. The Medicare DME improper payment rate calculated in the Comprehensive Error Rate Testing report was a shocking 52 percent in the latest report (see Eli's HCW, Vol. XIX, No. 8, p. 60), and much of that was due to physicians ignoring CERT requests for DME supporting documentation.

In previous years, the CERT contractor used "clinical judgment" and available medical and billing records to make claims determinations. "Now, the CERT contractor requires that physician records be present and does not consider additional available information until all of the documentation requirements are met," Medicare Administrative Contractor National Government Services acknowledges.

Accordingly, NGS is offering a letter that suppliers can send docs urging them to submit records for CERT reviews. The letter is from "The National DMEPOS Task Force" and assures physicians that submitting records isn't a HIPAA violation and is in fact the docs' responsibility under Medicare.

"In order for DMEPOS suppliers to continue to provide the necessary items/service to your patient, they must be able to rely on your cooperation in providing any additional documentation requested," the letter tells physicians. CERT denials "could result in your patient being financially responsible for all or part of the charges for the items/service received," the letter continues.

The full letter is on p. 18 of NGS's Medicare Monthly Review provider newsletter at www.ngsmedicare.com/pdf/MMR_2010_3.pdf. Or e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "CERT DME Letter" in the subject line for a free copy.

• Home care providers aren't the only little guys getting swept into Recovery Audit Contractors' latest approved review topics. Clinical social workers also are in the RACs' crosshairs.

And some of your social workers may findthemselves affected, if they also work for hospitals or nursing homes. Multiple RACs are looking for CSW services paid separately that should have been bundled into hospital or skilled nursing facility prospective payment system payments.

• Suppliers have until March 12 to registerfor the postponed Program Advisory and Oversight Committee meeting on DME competitive bidding. CMS moved the meeting to March 17 due to registration problems caused by severe winter weather in Baltimore.

Suppliers can register for the meeting at www.blsmeetings.net/paoc2010.

• A critical issue for physicians is affecting hospices as well. CMS has eliminated consult codes for docs, and that means hospices can't bill with them anymore either.

"Does the policy of no longer recognizing CPT consultation codes for the purposes of Medicare billing apply to billing for physicians' services in hospices, where the hospice bills Part A for the services of physicians on staff or working under arrangement with the hospice?" says a new question and answer set in MLN Matters article SE1010.

"Yes, when hospices bill Part Afor the services of physicians, they must use CPT codes that arepaid under the MPFS," CMS explains in the Q&A.

Why? "Since the CPT consultation codes are no longer recognized for payment under the MPFS, hospices must follow the same guidelines for reporting E/M services as physicians billing Part B,"CMS continues. "Hospices should use the most appropriate E/M codes to bill for E/M services furnished by physicians that could be described by CPT consultation codes."