Home Health & Hospice Week

Are you nailing all the details for transfer patients you accept?

If you get lazy with your transfer patient charting, you could have to forfeit your payment for those patients.

Home health agencies still have disputes over patients who transfer during an episode. Inquiries about such problems are "frequent," RHHI Cahaba GBA says in its June newsletter for providers.

An HHA accepting a transfer patient must inform the beneficiary that the original agency will no longer receive Medicare payment for her and will no longer provide services to her. "We encourage HHAs to include this information in their admission paperwork," Cahaba says in the recent Newsline. And the agency's documentation must show it.

The receiving agency must also document that it checked the patient's eligibility in the Common Working File. "A screenprint is required to document this," Cahaba instructs.

Finally, the agency must document its contact with the original HHA, informing it of the transfer. "This contact documentation must include: beneficiary's name; beneficiary's health insurance claim number (HICN); name of home health staff person who was contacted; and the date and time of the contact," Cahaba says.

"Assistance with transfer disputes should be requested only when HHAs have made every at-tempt, but are unable to resolve the issue themselves," Cahaba stresses.

Resource: A new form for requesting such assistance is at https://www.cahabagba.com/rhhi/forms/HHATransfer.pdf.

• You can look up the new durable medical equipment accreditation requirements in the Centers for Medicare & Medicaid Services' updated Program Integrity Manual. Starting July 1, DME Medicare Administrative Contractors (MACs) will reject a change of ownership application if the new owner doesn't have accreditation that covers all of its locations, according to CMS Transmittal No. 261 (CR 6078) issued June 27.

And accreditation for an acquisition isn't automatic, CMS warns. "If the new owner submits an application without evidence that the accreditation is still in effect for the new owner, the application should be rejected," the agency directs the DME MACs in the transmittal.

If even as little as 6 percent of a company changes ownership, the supplier must notify the National Supplier Clearinghouse or face "revocation action," CMS stresses in the transmittal. That applies even when the company keeps the same name and tax ID number.

Watch out: Suppliers booted from Medicare rolls for non-billing will have to obtain accreditation to get reenrolled, CMS adds. The same goes for suppliers deactivated for failing to respond to a reenrollment request.

A break: However, a supplier that's been revoked but has submitted "an acceptable corrective action plan" can be reactivated with no new accreditation requirements, CMS explains.

Suppliers with more than 25 locations also have until Sept. 30, 2009 to enroll additional locations without accreditation, the transmittal reminds suppliers.

The manual revisions are at www.cms.hhs.gov/transmittals/downloads/R261PI.pdf.

• Home care workers suffering under astronomical gas prices are getting a sympathetic ear. National Public Radio's Marketplace radio program's story about home care aides and gas prices ranked number one on its "Most Popular Stories Online."

Aide Stephanie Trancoso of Brooklyn Park, MN told Marketplace she's spending $20 a day on gas but only making a little over minimum wage. Many aides are considering leaving the profession due to the high price of fuel.

For example: Minneapolis resident and aide Nancy Zhao drives by three hospitals on her way home after work. "Every night, I think about quitting, and going to work at one of those hospitals," Zhao told Marketplace.

Congress reinstating the 5 percent rural add-on would help matters, the National Association for Home Care & Hospice's Val Halamandaris told the radio program. Gas tax rebates for home care workers would also decrease the burden of soaring gas prices on home care workers, Halamandaris suggested.

• In addition to fixing some long-standing PPS problems like miscounting early/late episodes, the July 7 fiscal intermediary shared system (FISS) update should also fix a recent problem affecting claims with line-item rates, notes regional home health intermediary Palmetto GBA on its Web site.

The problem: Since a June 2 system update, the Direct Data Entry (DDE) system has been removing line-item rate information and returning to provider (RTP'ing) the claim with reason code 32213, Palmetto explains.

The solution: A fix for this problem will go in with the July 7 update. But providers who want to submit claims earlier than that can press the "Enter" key after entering charges into DDE. "This should cause the rate(s) to be retained," Palmetto instructs providers. "The provider may then scroll forward using the PF8 key."

The workaround only works for manual data entry, Palmetto points out.

• Physicians may be receiving Medicare payment as usual under the budget impasse, but outpatient therapists aren't. The expiration of the therapy caps for Part B therapy went into effect July 1 as scheduled, CMS says in a message to providers.

"Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after July 1, 2008," CMS instructs. Providers can look up the amount patients have already used under the caps according to Common Working File instructions in www.cms.hhs.gov/transmittals/downloads//R759CP.pdf.

The $1,810 caps apply only to Part B outpatient therapy, not therapy services furnished under a Part A home health plan of care.

• Suppliers should get a look at their final quality standards in late July, CMS said in the June 25 Open Door Forum for home care and DME. The agency has finished going through public comments on the standards proposed in January and they are in the internal clearance process, said CMS' Sandra Bastinelli. They final standards will appear at www.cms.hhs.gov/medicareprovidersupenroll.

The standards include changes to areas such as operating hours, documentation requirements, contracted staff, signage and more (see Eli's HCW, Vol. XVII, No. 5).

• Another round of prospective payment system refinement corrections has resulted in yet one more update to the Home Health PPS Pricer.

CMS has updated the pricer "with a required logic fix and corrected revenue code rate factor," CMS explains in a notice to providers. You can download the new pricer online at www.cms.hhs.gov/PCPricer/05_HH.asp.

• You can get a look at the Joint Commission standards that will hit you next year if you're accredited by the organization.

The Joint Commission (formerly JCAHO) has issued its revamped home care standards on its Web site at www.jointcommission.org/Standards/SII/sii_hc.htm.

The standards may look pretty different, even though they don't technically contain new requirements. Under the Standards Improvement Initiative, the Commission reorganized chapter overviews, standards, introductions, rationales, and elements of performance for ease of use. It also split, consolidated, reordered and renumbered standards.

The Commission Web site includes history-tracking reports to show the differences between the new and old format.

• Florida's Medicare Fraud Strike Force has racked up three more home care convictions. A Miami-area mother and two daughters who ran two DME companies, a home health agency and an assisted living facility were convicted by a jury of fraud, false claims and kickback charges, according to a release from the U.S. Department of Justice.

The mother, Maria Hernandez, owned Action Best Medical Supplies Inc. while the daughters, Marta Jimenez and Maivi Rodriguez, owned Esmar Medical Equipment Inc., HHA A & A Medical Services Inc. and ALF M & M Comprehensive Inc. Patients testified at the trial that the women paid them cash kickbacks for use of their Medicare cards, according to the release.

They said they were falsely diagnosed with chronic obstructive pulmonary disease and prescribed unnecessary aerosol medications, including compounds. Medicare paid the sisters $14 million between 2000 and 2003 for the unnecessary medications, the DOJ says.

Strike Force-related prosecutions have netted 82 indictments of 142 defendants, the DOJ adds.

 • Meanwhile, Texas Attorney General Greg Abbott continues to pursue DME-related fraud in that state. The state's Medicaid Fraud Control Unit has arrested four Medicaid providers for DME fraud.

Humble, TX-based billing service Frazier Medical Marketing and its owners, Dyain Eligha Frazier and Tajuana Krischell Frazier, colluded with eight DME suppliers to bill Medicaid $6.1 million for supplies that were never furnished, according to Abbott. MFCU investigators arrested the Fraziers on June 10 at a luxury automobile dealership in Houston, the release says. The couple was attempting to trade in a 2006 Bentley for a new Mercedes-Benz and cash.

Authorities also arrested Charles Robertson Wickware and Vincent Alan Walker, operator of Dreammakers Medical Supply in Humble. Jacqueline Ann Briscoe, who operated Briscoe Medical Supply in Houston, is a fugitive.

Six other providers surrendered voluntarily, the AG says: Demetria Monique Boston and Marcus Lee Jefferson of Anointed Medical Supply in Houston, Wilma Perkins Gibson of Perkins Mobility in Houston, Christopher Charles Williams of Resource Solutions Medical Supply in Houston, and Robert Christopher Turner and Jeffrey Bernard Scales of First American Medical Supplies in Humble.

• Lots of home health agencies have signed up to try out P4P. The Home Health Pay for Performance demonstration project that lasts from Jan. 1, 2008 to Dec. 31, 2009 includes 569 home health agencies, CMS reports on its Web site.

In the demo project, HHAs from Connecti-cut, Massachusetts, Tennessee, Alabama, Georgia, Illinois and California were randomly assigned to either a study group or a control group. Study group agencies will have their patients' outcomes monitored during the demonstration and will be eligible for incentive payments (see more demo details in Eli's HCW, Vol. XVI, No. 22).