Home Health & Hospice Week

Medicare may have switched to using National Provider Identifier numbers for physicians, but that hasn't stopped a brouhaha over UPIN numbers from catching national attention.

A July 9 hearing of the Senate Permanent Subcommittee on Investigations focused on durable medical equipment claims that used deceased physicians' UPINs. "From 2000 to 2007, the UPINs of more than 17,000 deceased physicians were used on close to 500,000 erroneous claims that were paid over $76 million," said Subcommittee Chair Carl Levin (D-MI) in a statement for the hearing. "The failure to reject these claims raises questions about who at Medicare is safeguarding taxpayer dollars and why basic protections are not in place."

Fraudulent suppliers can easily obtain dead docs' numbers or can use the numbers in collusion with physicians, a New York Times article noted.

"Scam artists have treated Medicare like an automated teller machine, drawing money out of the government's account with little fear of getting caught," said Sen. Norm Coleman (R-MN), ranking member on the subcommittee.

New risk: The problem may get even worse under the new NPI system, pointed out the HHS Office of Inspector General's Robert Vito in testimony for the hearing. Currently the Centers for Medicare & Medicaid Services is allowing all Medicare providers, including DME suppliers, to put their own NPIs in the referring/ordering physician field on the claim.

"As long as DME suppliers are allowed to enter their own NPIs rather than the NPIs of the ordering physicians, a major control for preventing fraud, waste and abuse will not exist," Vito warned.

Rebuttal: "Durable medical equipment manufacturers and providers are just as appalled as lawmakers and Medicare officials at the revelations that scam artists used identification numbers from deceased doctors to bilk millions of dollars from the Medicare system," fired back the American Asso-ciation for Homecare in a statement about the hearing's findings. Suppliers who perpetrated such fraud "are not part of the legitimate home care industry," the trade group pointed out.

AAHomecare urges CMS to adopt accreditation standards for suppliers and to enforce its current supplier standards with surprise on-site inspections. "Lax oversight" by CMS has "allowed the dead-doctor scams to operate," the group insists.

CMS will begin double-checking Social Security death information against physician information on claims, CMS' Herb Kuhn said at the hearing. And the reenrollment required by the NPI process should weed out many deceased physicians' numbers, Kuhn added.

The fraud details are "gory," said the USA Today in a July 10 op-ed piece. But "obsessing over the dead-doctor scam is a little like focusing on the guy stealing some silverware from the kitchen when the house is on fire," the newspaper maintained, noting the overall reimbursement impact is a tiny piece of Medicare spending.

• Competitive bidding isn't the only provision of the recently enacted Medicare bill to affect home care providers. The Medicare Improvements for Patients and Provider Act also extends the exceptions process for Part B therapy caps for 18 months. The cap applies only to Part B therapy, not therapy furnished under a Part A home health plan of care.

"Claims submitted with the therapy cap exception modifier will be processed as soon as the payment rates have been activated," CMS says in a message to providers. "Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008," CMS in-structs on its Web site.

Your responsibility: "Claims submitted without the [therapy cap exception] modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement," CMS says in the message. Providers that received rejected claims should resubmit them while providers that received denied claims should request adjustments, CMS says on the Web site at http://www.cms.hhs.gov/TherapyServices.

If a beneficiary paid you for services that now qualify for the exception, you should refund the payment, CMS mandates.

Reminder: For Part B physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,810 for 2008. For occupational therapy alone, the limit is $1,810.

• Home care workers' burden under mounting fuel prices continues to receive national attention, which could bolster home health agencies' efforts to secure a reinstatement of the 5 percent rural add-on.

The Northern Montana Home Health Care and Bear Paw Hospice in Havre, MT, is looking at discontinuing service in the state's back country, director Lisa Genereux told the Associated Press.

Aides for North Country Home Services in New York's Adirondack Mountains have had to borrow gas money from office staff, the Saranac Lake agency's assistant director Kathy Liddell told AP.

Some agencies are coming up with creative solutions to combat the high prices. AristoCare Home Health Services in Arizona and California recently began paying a $10 to $15 travel stipend for trips outside downtown Tucson and uses computer mapping software to reduce the number of miles workers drive between assignments, AP reports.

Bons Secours Home Care in Newport News, VA is providing 15 fuel-efficient Toyota Corolla rentals for its nurses, AP says. The nurses pay $150 a month for the car, they can drive it for personal use, and the agency pays for gas for the first 20,000 miles driven each year.

"As soon as we were able to start offering these cars, I had people knocking down my doors," said director Sharon Riddick. "Now I'm fully staffed for the first time in seven years."

• Hospices soon will be able to use a new condition code if they discharge a patient for cause. Code H2 indicates "the patient meets the hospice's documented policy addressing discharges for cause," CMS explains in July 18 Transmittal No. 1558 (CR 6115). The move "results only in a discharge from the provider's care, not from the hospice benefit," CMS adds.

The code is effective Jan. 1, CMS notes in a MLN Matters article.

"Currently, discharge for cause is not identified on the Medicare claim," CMS observes in the article. "In order to identify these discharges ... CMS asked the National Uniform Billing Committee (NUBC) to approve a new condition code."

The transmittal is at http://www.cms.hhs.gov/transmittals/downloads/R1558CP.pdf. The MLN Matters article is at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6115.pdf.

• DME suppliers have billing changes coming their way. First, starting Jan. 1, the ViPS Medicare System must recognize new DME supplier specialty codes. The codes are B2: Pedorthic Personnel; B3: Medical Supply Company with Pedorthic Personnel; and B4: Rehabilitation Agency, CMS explains in July 18 Transmittal No. 1552 (CR 5930).

The transmittal is online at http://www.cms.hhs.gov/transmittals/downloads/R1552CP.pdf.

Secondly, starting July 1, 2009, Medicare's ViPS Medicare System must "capture and process" up to eight diagnosis codes for DME claims. All eight codes, if included, must also be shared with the Common Working File and the National Claims History, CMS says in July 18 Transmittal No. 360 (CR 6068).

The transmittal is online at http://www.cms.hhs.gov/transmittals/downloads/R360OTN.pdf.

• Palmetto GBA will continue serving as Medicare's National Supplier Clearinghouse, the contractor says in a release.

"CMS awarded Palmetto GBA a one-year base contract with four one-year options," the NSC says. "If all options are exercised, the contract will have a value of approximately $76 million."

Palmetto has been the NSC contractor since 1993, it says in the release.

• Fall prevention programs cut falls among the elderly by 11 percent in a new study by Yale School of Medicine researchers.

The researchers "used a combination of fall prevention educational campaigns and interventions aimed at encouraging clinicians to incorporate fall-risk assessment and management into their practices," according to a release from the school.

The study is the first to examine the effects of fall prevention strategies when used by elderly patients' own health providers -- including home care nurses -- instead of researchers.

"We weren't expecting such great results because it can be difficult to adapt new strategies into patient care," said study author and Yale physician Mary E. Tinetti. "We are now looking at ways to make these interventions and strategies available to the rest of the state and country."

The study appeared in the July 17 New England Journal of Medicine.

• An Administrative Law Judge has upheld the HHS Office of Inspector General's penalty against a Clearwater, FL-based DME supplier. Last month ALJ Steven T. Kessel affirmed the OIG's imposition of a $100,000 civil money penalty, a $42,220 assessment, and a seven-year exclusion against Cary Frounfelter and Kast Orthotics and Prosthetics Inc., the OIG notes in a release.

Frounfelter and Kast falsely claimed they provided custom-made orthotic devices after beneficiaries had been discharged from HealthSouth Rehabilitation Hospital in Largo, FL, or within a 48-hour window prior to discharge, the OIG alleges. They then illegally billed the devices to Medicare Part B.

• Brighter lights in homes, nursing facilities and other sites of dementia care could stave off some mental decline among patients with Alz-heimer's disease and other forms of dementia, ac-cording to a new study.

A study published in the June 11 issue of the Journal of the American Medical Association looked at 189 people living in group care facilities. The average age of the individuals was 85.8 years, and 87 percent had dementia. Six of the facilities turned on bright lights installed in ceiling-mounted fixtures for about nine hours each day, and some participants received melatonin hormone (2.5 mg) or placebo. After up to 3.5 years, bright light reduced cognitive deterioration by a relative 5 percent, depressive symptoms by 19 percent and the gradual increase in functional limitations by a relative 53 percent, the researchers report.

Melatonin reduced the time to fall asleep by a relative 19 percent and increased total sleep duration by 6 percent. In combination with bright light, melatonin reduced aggressive behavior by a relative 9 percent.

Resource: To read the abstract of the study, go to http://jama.ama-assn.org/cgi/content/abstract/299/22/2642.