Home Health & Hospice Week

Nearly a month after Medicare's new oxygen payment policy took effect, CMS is issuing some details about how to bill under the confusing new system.

Clarification: Oxygen providers can deliver up to three months' worth of oxygen contents at one time, the Centers for Medicare & Medicaid Services instructs in a Jan. 26 provider education article CMS e-mailed to providers. You would still bill monthly for the oxygen you provided.

"In these situations, the delivery date of the oxygen contents does not have to be the DOS (anniversary date) on the claim," CMS explains. "However, in order to bill for contents for a specific month, you must have previously delivered quantities of oxygen that are sufficient to last for one month following the date of service on the claim. You are required to have proof-of-delivery for each actual delivery of oxygen, but ... this may be less often than monthly."

Example: "If you deliver 30 oxygen tanks on April 11th and the beneficiary only uses 15 tanks from April 11th through May 10th and 15 tanks from May 11th through June 10th, you may bill for contents on April 11th and again on May 11th for contents delivered on April 11th that were used for two months," CMS adds.

CMS tells suppliers to use HCPCS codes E0441 through E0444 to bill for the contents, but admits that the codes aren't exactly right. "The descriptors ... reflect older policies and regulations and need to be revised," CMS explains. "For now, each of these four codes represents monthly delivery of either stationary or portable oxygen contents. The language in parentheses in the descriptors for each of these codes should be disregarded."

The article also reviews policies for replacement of DME equipment, the reasonable useful lifetime, and when a break in service allows a new cap period to begin. CMS will codify the guidance in a forthcoming transmittal and MLN Matters article, CMS promises.

One major unanswered question is about the calculation of reasonable useful lifetime, which determines when a new cap period begins. "We've seen conflicting information" about the term, says provider network VGM Group in Waterloo, Iowa.

For a copy of CMS's six-page education article, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "Oxygen Contents Article" in the subject line.

• As the Congressional session gets rol-ling, home care providers are hopeful that industry-specific legislation will help them out. In addition to hospice BNAF delay provisions in the House version of the economic stimulus bill (see Eli's HCW, Vol. XVIII, No. 4, p. 32), home health agencies hope legislators will include a 5 percent rural add-on provision in the Senate version. In a Jan. 22 letter, former Sen. Bob Dole, representing the National Asso-ciation for Home Care & Hospice, called on Sen-ate Finance Committee Chair Max Baucus (D-Mont.) to include the add-on in the legislation, NAHC reports. Lawmakers hope to pass a stimulus bill by mid-month.

And Finance Committee Ranking Member Charles Grassley (R-Iowa) has introduced a rural health bill that calls for exemption of rural areas from DME competitive bidding and for physician assistants to order post-acute care like hospice services.

• HHAs in Michigan are working hard on their quality scores as they anticipate Medicare's pay-for-performance demonstration becoming permanent. Nearly 570 agencies in seven states -- Connecticut, Massachusetts, Tennessee, Alabama, Georgia, Illi-nois, and California -- are in the middle of the two-year P4P demo, CMS notes on its Web site.

Even though Michigan isn't a demo state, its HHAs are already gearing up for possible P4P, reports Crain's Detroit Business newspaper.

For example, Oak Park-based Visiting Nur-ses Association of Southeast Michigan and Guardian Angel Home Care Inc. in Rochester Hills use telehealth to improve outcomes, they say. The VNA also uses outcome score cards generated by its outcomes data vendor, which shows clinician-level data, says the agency's Linda Pekar. The scorecard system has helped the VNA cut its hospitalization rate 5 percent over the past year, Pekar told the newspaper.

Henry Ford Home Health Care in Detroit has improved surgical wound quality measure scores 5 percent in the past two years, says the agency's Greg Solecki. The HHA sent nurses back to school to get certified in wound ostomy and continence nursing, and those nurses have mentored others, improving their wound care, Solecki told the newspaper.

• A ruling over New York's Medicaid program may make home care more difficult to access across the country. That state's Medicaid program provides the same "spend-down" limit for home care patients as it does for nursing home patients, reports the New York Times. In other words, the level to which spouses must spend down their assets before Medicaid will begin paying for care is the same for both settings.

But now CMS has told the New York Health Department that the same levels shouldn't apply. The 1988 law with the spousal impoverishment provisions meant for Medicaid to extend the protections for home care only to the neediest Medicaid beneficiaries, CMS says.

"The root of their interpretation is that Congress wanted to give states the option of extending these protections, but only to those whose incomes are so low that they would have no income to share with their spouse," elder advocacy attorney Valerie J. Bogart told the Times. "It would be so absurd that no one would ever qualify."

State officials hope the Obama administration will overturn the Bush administration decision.

• HHA claims are continuing to get snarled. Both regional home health intermediaries Palmetto GBA and Cahaba GBA report that claims are incorrectly rejecting with reason code C7080.

"Reason codes C7080 and C7251 indicate services are overlapping with another claim," Cahaba says on its Web site. The overlaps are between home health and inpatient claims, Palmetto adds.

Palmetto agencies are still having trouble with claims in location S M95HG too, it reports. That error occurred because multiple claims received the same Document Control Number (DCN). Pal-metto earlier advised affected HHAs to seek accelerated payments for the problem.

"We have run the most recent utility supplied and issues were found with the output," Palmetto says on its Web site. "The issues have been reported and the maintainer is currently researching."

Meanwhile, Cahaba has resolved the issue that put claims in status/location S MSWHH. Those claims "are in the process of being released to allow continued processing," the intermediary reports.

But don't assume everything is all fixed now. "Some claims impacted by this issue may not have been identified and moved to status/location S MSWHH," Cahaba says. "Therefore, if after researching your claims in the return to provider (RTP) file with reason codes U5600, U6000, U5106, or U538F, you feel they are in RTP inappropriately as a result of this issue, contact the Provider Contact Center (PCC) for assistance."

Do the same if you have claims that have been suspended (status S) for more than 30 days and look suspicious after research, Cahaba instructs.

• Suppliers' hopes for significant reform to competitive bidding are hanging on an order from the Obama administration. As is customary with incoming presidential administrations, White House Chief of Staff Rahm Emanuel issued a memo Jan. 22 directing federal agencies to stop pending rules until the new administration has time to conduct a review of each one, according to the Washington Post.

The American Association for Homecare and the National Association for Independent Medical Equipment Suppliers are asking Congress to review and rescind the new final rule issued Jan. 16 under the policy, the trade groups say.

• CMS has extended for three years a demonstration project for disease management of chronically ill, high-cost Medicare beneficiaries. CMS awarded the extensions to Key to Better Health, a division of Village Health in New York; Massachusetts General Care Management Pro-gram in Boston; and Health Hero Network, Health Buddy Project in Oregon and Washington.

"The programs in the demonstration have had a positive impact on selected high cost Medicare beneficiaries and have met and/or exceeded the savings target required in the demonstration agreement," CMS says in a release. "By extending the demonstration for another 3 years ... each of the programs would have the opportunity to continue to impact their populations, maximize savings, and assist CMS in determining the replicability of the programs."

• The need for home care services continues to grow. In 2008, about 9 million people will need long-term care services, reports insurance company Genworth Financial. In 2020, that number is expected to jump to 12 million, it says.

• Baton Rouge, La.-based chain Amedisys Inc. plans to purchase three home health agencies and one hospice agency from the White River Health System in Batesville, Ark., it says in a release.

The acquisition will extend Amedisys' service area to seven new counties in the state, the company says. The agencies have annual revenues of $2.9 million.