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Home Health & Hospice Week

Industry Notes:

CMS Takes One More Step Toward Appeals Reform

Published on Thu Oct 21, 2004

Eight Qualified Independent Contractors named - finally.

If you thought the Medicare appeals reform changes mandated by BIPA would never come, you may be in for a pleasant surprise.
 
The Centers for Medicare & Medicaid Services has named eight Qualified Independent Contractors (QICs) - independent appeals entities required by the 2000 Medicare law. QICs will replace the "fair hearing" level of appeals for suppliers and will be part of a brand new, second level of appeals for home health agencies and hospices, CMS explains in a release.
 
Some observers believe QICs may give home care claims a more unbiased hearing than carriers or intermediaries (see Eli's HCW, Vol. XIII, No. 36, p. 284). The contractors named will be able to bid on HHA, supplier and other provider type workloads.
 
CMS aims to complete its overhaul of the Medicare appeals system by Oct. 1, 2005, it pledges. Changes will include a new system allowing parties to track their appeals online in real time, a 60-day decision deadline, and improved first-level appeal notices indicating the specific reasons for the determination.
 
The QICs are: Integriguard; Q Administrators; Island Peer Review Organization; Rivertrust Solutions Inc.; Computer Sciences Corp.; Maximus; First Coast Service Options Inc.; and Permedion.

 

  • Authorities soon may be cracking down on flu vaccine price gouging. Department of Health and Human Services Secretary Tommy Thompson is urging state attorneys general to target the practice, which has surfaced after the flu vaccine shortage.
     
    "It is extremely disturbing to learn of reports of price gouging by immoral individuals looking to make a quick buck off of a public health challenge," Thomp-son wrote in a letter to AGs. The Centers for Disease Control and Prevention is collecting reports on price gouging and sharing the information with the National Association of Attorneys General and state prosecutors, the letter says.

     

  • Just to make your billing more confusing, a claims processing error at durable medical equipment regional carrier CIGNA HealthCare Medicare Administration is sending denials for duplicate claims when they've really been processed. "If your office submitted electronic claims beginning approximately 09/20/04 through 10/13/04, you may have inadvertently received denials for duplicates," CIGNA warns in a listserv message.
     
    CIGNA processed the original claims correctly, but the error caused the electronic claims to stay in the mailbox and be processed again - and thus be denied as duplicates. You may be one of the lucky ones, however; the error didn't affect all suppliers.

     

  • The Congressional Budget Office has shot down claims that disease management programs cut health care costs. "There is insufficient evidence to conclude that disease management programs can generally reduce overall health spending," CBO says in its study of peer-reviewed DM literature. "It is important to note that such programs could be worthwhile even if they did not reduce costs, but CBO's analysis focused on the question of whether those programs could pay for themselves." The Oct. 13 report is at www.cbo.gov.

     

  • Don't forget to celebrate National Home Care Month with your staff, referral sources and communities in November. The slogan designated by the National Association for Home Care & Hospice is "The Center of Healthcare in America."

     

  • Beware: That great client of yours could just be a federal agent, as C&H Medical Supply Inc. recently learned the hard way.
     
    The president and a sales rep of a Abington, PA-based DME supplier thought they were doing business with a home health agency, but it was run by undercover federal agents. Charles Leiber and Jeffrey P. Dubin were charged Oct. 6 with paying kickbacks and bribes to "Chosen Care" HHA from May to December 2000.
     
    C&H allegedly agreed to pay 40 percent of its government profits in exchange for the HHA's referral of Medicare and Tricare business. The payments were disguised as "commission" to the HHA manager, U.S. Attorney Patrick L. Meehan says. The defendants could face up to 15 years in prison and a $750,000 fine.

     

  • A Houston-area supplier has been sentenced to almost four years in prison and fines approaching $2 million over a power wheelchair scam, according to Matthew D. Orwig, U.S. Attorney for the Eastern District of Texas. Becalo (Becky) Utuk, manager of All Divine Health Services in Luftkin, TX, pleaded guilty to $4 million in Medicare fraudulent billings June 25 (see Eli's HCW, Vol. XIII, No. 24, p. 190).
     
    Medicare paid nearly $1.8 million to All Divine for the wheelchairs, which weren't medically necessary and often weren't delivered, Orwig says. Utuk diverted the fraud proceeds for her own personal use and benefit, he charges. After an Oct. 12 sentencing, she faces 46 months in prison and $1.76 million in restitution.

     

  • Lincare Holdings Inc. saw increased earnings this quarter, despite a $14 million reduction in revenues for Medicare respiratory medications due to rate cuts this year. Clearwater, FL-based Lincare reported net income of $70.4 million on revenues of $322.0 million for the quarter ended Sept. 30, compared to a $60.4 million profit on $296.3 million in revenues for the same period in 2003.
     
    Lincare acquired four companies in the quarter  and opened 20 more locations to total 787 offices. Lincare dialed back its acquisitions in the quarter, waiting on news of 2005 reimbursement rates (see story, p. 299).

     

  • Community Hospital in Torrington, WY is the latest hospital to shed its home care program. The Banner Health-owned hospital HHA will close its doors Dec. 31, reports The Torrington Telegram.

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