Home Health & Hospice Week

CMS reveals more bidding program details at PAOC meeting.

Suppliers wondering how the relaunch of competitive bidding will affect them got more details at a Centers for Medicare & Medicaid Services meeting in Baltimore June 4.

CMS had earlier announced that the bidding process would begin this fall (see Eli’s HCW, Vol. XVIII, No. 21, p. 163). At the Program Advisory and Oversight Committee (PAOC) meeting, the agency distributed a more detailed timeline listing bidding activities for 2010, including announcement of bid winners next summer, the American Association for Homecare notes. Round one would then go live in January 2011.

AAHomecare representatives engaged in “heated discussion” with CMS during the meeting, the trade group says. Chief concerns were that CMS is underestimating the number of suppliers that is sufficient to serve a bid area and is setting prices unfairly under the program.

Industry reps pointed out bidding’s “severe deficiencies” during the meeting, Elyria, Ohiobased Invacare Corp. says on its Web site.

Meanwhile, the industry continues its fight on Capitol Hill to delay or eliminate the bidding program altogether. More than 300 industry reps visited lawmakers in Washington, D.C. the first week of June to press their case against bidding and the oxygen cap, notes the National Association of Independent Medical Equipment Suppliers.

Some good news is that the Obama administration has continued to leave durable medical equipment out of its proposals for budget cuts to fund overall health care reform, NAIMES notes.

• Be careful of what your employees may be up to behind your back, because it could bring the feds knocking. In its latest semiannual report to Congress, the HHS Office of Inspector General highlights a fraud case involving a DME supplier and a home health agency nurse who was fired for improper conduct.

According to the OIG, Valerie Tolley, doing business as Health Care Medical (HCM), allegedly arranged for Sherrie Alexander, a nurse employed at Sta-Home Home Health Agency, to obtain patient census rosters. HCM used the rosters to solicit DME sales and paid Alexander for every completed sale. Sta-Home fired Alexander in 2003 when it learned of the arrangement.

HCM also allegedly offered sales personnel kickbacks if they obtained patient information that HCM could use in making targeted DME sales, the OIG says.

HCM agreed to a three-year certification of compliance agreement (CCA) and to pay $100,000.

A CCA is a shorter version of a corporate integrity agreement (CIA).

Hospice: The semiannual report also highlights the SouthernCare Inc. case, in which the Birmingham, Ala.-based hospice chain agreed to a $25 million settlement with the OIG earlier this year for billing for ineligible patients (see Eli’s HCW, Vol. XVIII, No. 5, p. 34).

The report is online at www.oig.hhs.gov/publications/docs/semiannual/2009/semiannual_spring2009.pdf.

• The Department of Health and Human Services and the Department of Veterans Affairs will partner to furnish grants for home-based long term care, the agencies say in a release.

Their “ultimate goal [is] a nationwide home and community-based long-term-care support program to serve older Americans and veterans of all ages,” they say. About $10 million in grants will go to 20 states. More information is at www.aoa.gov/AoARoot/Grants/Funding/index.aspx.

• If you need to bill a pre-election evaluation, you’d better hold off on the notice of election for the hospice patient. “Since the pre-election evaluation occurs prior to the election of hospice benefits, the NOE would need to be billed after the pre-election evaluation claim has paid,” explains regional home health intermediary Cahaba GBA in new frequently asked questions.

More Cahaba FAQs are at www.cahabagba.com/rhhi/faqs/faq_hh_hospice.htm.

• Pretty soon, any fraud contractor that’s interested will be able to rifle through your durable medical equipment claims.

“Currently, only one Program SafeguardContractor (PSC) can access a DME MAC’s claims data,” the Centers for Medicare & Medicaid Services notes in June 5 Transmittal No. 501 (CR 6430). But Zone Program Integrity Contractors (ZPICs) are now taking over fraudfighting activities from PSCs, and the new ZPIC territories often cover more than one DME MAC’s jurisdiction.

CMS “will allow access to a MAC’s claims data by multiple PSCs” -- and later ZPICs -- “and  for the PSC to extract only data that concerns claims in their service area,” the memo says.

• The instructions you got to fix the revenue code line problem with the latest DDE update may not work as well as you hoped. “The instructions given may not work for all providers and there are several factors as to why,” says regional home health intermediary National Government Services in an e-mail to providers. “Providers’ keyboards may be set up differently or there may be differences if you work on a laptop versus a computer, just to name a few.”

Or it may be something as simple as the order you’re doing things. “Please ensure that all corrections to the claim are made before you PF9,” RHHI Palmetto GBA reminds agencies on its Web site. “Please remember that the line will not disappear from the screen until you PF9.”

The DDE problem will be corrected with the system’s July 6 update, the intermediaries reiterate.

• CMS and the Agency of Healthcare Research and Quality have concluded their research on negative pressure wound therapy, but NPWT proponents may not like their findings. “The available evidence does not support significant therapeutic distinction of a NPWT system or component of a system,” CMS says.

In other words, no one NPWT system or part deserves its own HCPCS code, CMS says.

CMS will hold a July 9 public meeting to give “stakeholders an opportunity to provide input concerning the preliminary decision,” the agency says.

The study backing up CMS’s decision is at www.ahrq.gov/clinic/ta/negpresswtd/npwtd01.htm.

• If you’re struggling to find an appropriate diagnosis code for the swine flu -- technically known as the H1N1 virus -- the CDC has a solution, but not until fall. A new revision to the ICD-9 code set effective Oct. 1 adds specific codes for swine and avian flu.

The Centers for Disease Control’s National Center for Health Statistics announced two addenda to the ICD-9 code set: 488.0 (Influenza due to identified avian influenza virus), and 488.1 (Influenza due to identified novel H1N1 influenza virus). “These codes have been created to provide data capture for the novel H1N1 influenza virus (swine flu virus), which was first identified in April, after the March 2009 ICD-9-CM Coordination and Maintenance Committee meeting,” the CDC indicates on its Web site at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm.

Resource: To sign up for an Aug. 19 Elisponsored audioconference about the new 2010 diagnosis codes, go to www.audioeducator.com/industry_conference.php?id=1528 or call 1-800- 508-2582.

• An owner of a Michigan home care recruiting and marketing company has pled guilty to conspiracy in Detroit U.S. District Court, reports Crain’s Detroit Business newspaper. Rebecca Sharp, owner of recruiting company Continuing Senior Care Co Inc. and Marketing & Assessment, could face five years in prison and more than $5 million in restitution and fines for her part in a kickback scheme, the paper says.

Sharp allegedly told her employees to phone seniors to offer medical and aide services. A doctor employed by Sharp then visited the Medicare beneficiary and prescribed home care services regardless of medical necessity, Michigan U.S. Attorney Terry Berg said in announcing the indictment last year. “After obtaining patients with Medicare coverage, Sharp referred the individuals to home health care agencies in exchange for a fee,” according to a release.

HHA owners accused of paying kickbacks to Sharp include Nancy Razalan of New Century Home Health Care Inc. in Madison Heights, Generosa Agustin of Family Care Choice and Services Inc. in Southfield, Kevin Watson of Watson Health Care Inc. in Southfield, Jaqueline Jackson of Superior Home Care Inc. in Southfield, Hafiz Anjum of Open Arms Home Care Inc. in Southfield, and Michael Gilliam of Quality Home Health Care Services of Michigan Inc. in Southfield.

Administrator Edwin McBeth, formerly of Tender Nursing Home Care in Wixom, is also accused. No doctors were indicted in the scheme.