Home Health & Hospice Week

Check your claims data carefully.

You could prevent holdups to your cash flow by avoiding simple date problems.

Four of home health agencies' top submission errors involve incorrect dates on claims, says regional home health intermediary Palmetto GBA in its new review of the top 10 submission errors from October 2007.

Reason code 31755 occurs when the From, Thru and 0023 line item dates don't agree. For example, if the From and Thru date are the same, the 0023 date must also match, Palmetto explains.

Reason code 31018 shows up when your claim tries to make the patient's prospective payment system episode greater than 60 days. You can verify the episode dates through HIQH, Palmetto advises.

HHAs see reason code U5386 when the line item date doesn't fall within the 60-day episode. This is often due to a canceled request for anticipated payment (RAP), the intermediary points out.

Reason code 32907 is a similar problem, noting the requirement for line item services to fall within the 60-day period. Other top submission errors included trying to submit final claims when no RAPs for the episodes exist (38107); the now-defunct M0175-related incorrect HIPPS code based on prior inpatient stay (C727); incorrect beneficiary information (T5052 and N5052) and missing units for required revenue codes (32226).

For more on the top submission errors and ways to avoid or solve them, see www.palmettogba.com or email editor Rebecca Johnson with "Top Submission Errors" in the subject line.

• Oxygen suppliers may have a little less claims trouble than they expected from a new requirement. Last November, the Centers for Medicare & Medicaid Services established pre-payment autodenial edits for oxygen suppliers, the agency says in April 18 Transmittal No. 1493 (CR 5929).

The National Supplier Clearinghouse is supposed to "assign an oxygen specialty code to all suppliers who have indicated they will be providing oxygen and/or oxygen related services on their CMS 855S enrollment application," CMS explains in the transmittal. Then DME MACs are supposed to "edit claims to look for the oxygen specialty code and submit a quarterly report of oxygen and/or oxygen related equipment DMEPOS supplier false claim submission attempts to CMS."

Then "the NSC shall research the reported DMEPOS suppliers," CMS says.

Maybe not you: But the NSC will actually assign the codes only to suppliers in the 38 states that license or certify them for oxygen provision.

And the DME MACs now aren't editing for the specialty codes, CMS says in a new MLN Mat-ters Article (5929). "DME MACs are currently processing [oxygen] claims from enrolled and approved DMEPOS suppliers without regard to the specialty identified and services to be provided on the enrollment application form (CMS-855S)," CMS says.

The transmittal is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5929.pdf. The article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5929.pdf.

• HHAs around the nation should watch what's happening in New York as a sign of things to come. After a high-profile crackdown on Medicaid aide fraud in New York City that netted many convictions and judgments for millions in restitution, the state subpoenaed 27 agencies in upstate New York, reports the Associated Press.
 
The state doesn't accuse the 15 Syracuse-area agencies, seven Buffalo providers and five Rochester HHAs of wrongdoing, but says the industry needs closer supervision.

"The concept is right," Attorney General Andrew Cuomo said about home care at a news conference. "We want to clean up the fraud."

"Providers of quality home care services have an equal, if not greater, stake in curbing fraud and abuse because the misdeeds of a few rogue individuals have the potential to tarnish the entire home care community," says Joanne Cunningham of the Home Care Association of New York State in a release. "HCA hopes that this broad-brush approach doesn't impair the vast majority of agencies that are diligent and committed to providing quality home care to those most in need."

• If you're having trouble with the Medicare enrollment process, a new transmittal may offer help. CMS' Program Integrity Manual now includes provisions requiring more detailed denial, revocation and reconsideration letters, the agency says in April 11 Transmittal No. 251 (CR 5826).

The provisions were mandated by the Medicare Modernization Act, CMS notes. The transmittal is at www.cms.hhs.gov/transmittals/downloads/R251PI.pdf.

• HHA billers may have to brush up on their math skills. The claims system continues to sometimes issue two remits for home health claims, RHHI National Government Services admits in an April 17 posting to its Web site. One remit is for the National Provider Identifier number while the other is for the legacy six-digit Medicare provider number.

What to do: Add the two remits together to reconcile your electronic payments, NGS advises. "If there is an NPI remit for $5,000 and legacy Medicare number remit for $6,000, then there should be ONE bank deposit for $11,000," the intermediary explains.

Paper remits each come with a corresponding check for that amount, NGS adds.

• Suppliers of parenteral and enteral nutrition may have a smoother Medicare payment road ahead starting this fall. Currently a Medicare claims system edit denies PEN claims if the beneficiary is lacking a recertification for the items after six months. But a local coverage determination (LCD) from the DME program safeguard contractors eliminated that requirement last year, CMS says in April 18 Transmittal No. 82 (CR 5914).

The claims system is still denying the claims without those recerts and the DME PSCs manually correct them. Starting in October, the edits will be removed altogether, CMS says.

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R82NCD.pdf.

• If you're finding it difficult to figure out PPS adjustments, just look to your remittance advices, RHHI Palmetto GBA told agencies in a March 5 Ask-The-Contractor teleconference about PPS billing.

"As in the original Home Health PPS, the electronic RA, or remittance advice, now shows the HIPPS codes submitted on the claim and the HIPPS code that was used for payment," Palmetto says in a recent summary of the teleconference. Thus "adjustments can be clearly identified."

• The nation should prepare for a health care worker crisis as baby boomers become seniors, the Institute of Medicine says in a recent report on the health care workforce. "The number of older patients with more complex health needs increasingly outpaces the number of health care providers with the knowledge and skills to adequately care for them," the IOM says in the report, Retooling for an Aging America: Building the Health Care Workforce.

As the nation's baby boomers reach age 65 and beyond, "fundamental changes in the health care system need to take place, and greater financial resources need to be committed to ensure they can receive high-quality care," the influential IOM says. "Right now, the nation is not prepared to meet the social and health care needs of elderly people."

The report is at www.iom.edu/CMS/3809/40113/53452.aspx.

• Home care providers hoping their states will put more money into home care and reduce long-term care spending in institutions have an uphill battle against nursing home lobbyists. Home health agencies in Pennsylvania are learning that lesson the hard way, since Gov. Ed Rendell (D) is trying to rebalance LTC spending in favor of home care.

A nursing home lobbying coalition called Pennsylvanians for Quality Care and the nursing home trade group Pennsylvania Health Care Association told a recent state Senate panel hearing that nursing homes were getting shortchanged in the process of funding more home care, according to the Associated Press.

"A claim by nursing home interests that home health care is draining resources from nursing homes is 'factually false and destructive to broad-based efforts to make limited public dollars go further in providing medical and health services for all Pennsylvanians,'" fires back Vicki Hoak of the Pennsylvania Homecare Association in a release.

"The nursing home industry has seen its reimbursement rates climb 22 percent in just the past five years," Hoak notes. "By contrast, home health care providers have not seen an increase in reimbursement rates for four years. Before that increase, the reimbursement rate had been stagnant for thirteen years."

• Home care providers accredited by the Joint Commission (formerly JCAHO) can rest easy with their decision for another six years. CMS has renewed the Joint Commission's deeming authority for that period, which means providers surveyed by Joint Commission surveyors don't have to undergo a Medicare survey as well.

The Joint Commission Home Care Accreditation Program accredits more than 3,800 providers, the Oakbrook Terrace, IL-based organization says.