Home Health & Hospice Week

Starting this fall, physicians won't be knocking on your door asking for therapy payment. Outpatient therapy services are bundled into home health consolidated billing under the prospective payment system, but not if it is a physician rather than a therapist who furnishes the PT, the Centers for Medicare & Medicaid Services clarifies in May 2 program memorandum B-03-037. The claims processing system currently doesn't differentiate between doc- and therapist-furnished PT and is denying therapy payment for physicians when the patient is under a home health plan of care. Contractors will fix the problem by Oct. 1, CMS says in the memo. Regional home health intermediary Palmetto GBA is touting the $872 million it withheld or recouped from providers in 2002 as costs savings to the government. Palmetto's benefit integrity unit helped "identify and pursue highly abusive and/or fraudulently billed services" to the tune of $98.8 million. Provider audits recovered $101.8 million and secondary payor efforts resulted in $400 million, the RHHI cheers in a statement. While it is generally clear which supplies home health agencies must pay for under PPS consolidated billing, the level of supplies that they must cover is more in question. "It is up to the HHA and the physician to determine what is a medically necessary quantity for each beneficiary," RHHI Cahaba GBA says in its May 1 Newsline. "Supplies above and beyond what is considered medically necessary do not have to be provided by the HHA," Cahaba clarifies. CMS isn't the only one furnishing quality information on providers. The Joint Commission on the Accreditation of Healthcare Organizations also will begin issuing its own quality reports in 2004. They will outline a provider's accreditation information and compliance with JCAHO's national patient safety goals. The new reports, which will be available online and on paper, will replace organization-specific performance reports first published almost nine years ago, the accrediting body says. Gentiva Health Services Inc. has reported net income of $5.2 million on revenues of $202.0 million for the quarter ended March 21, compared to a loss of $209.2 million on revenues of $192.8 million for the same period in 2002. The Melville, NY-based home nursing giant saw its commercial payor business revenues increase 7.7 percent, while its Medicare and Medicaid increases were closer to 1 percent, CFO John Potapchuk said in a May 6 conference call with investors. The company expects to have repayments related to partial episode payment (PEP) adjustments and cost report settlements of $8 to $12 million in 2003, Potapchuk said. Gentiva has a sizeable amount of cash, and investors made it clear in the call they would view use of it for anything other than a stock buy-back with "great displeasure." Gentiva is [...]