Home Health & Hospice Week

The January Medicare claims system update has fixed a number of home health claims problems that were outstanding, regional home health intermediaries report.

Claims affected by some of the problems are now processing automatically while providers will need to act on others, RHHI Cahaba GBA notes on its Web site.

For example: Previously, some claims that were recoded due to having 20 or more therapy visits were having their HIPPS code removed from the claim. Claims affected by that error that are in the return to provider (RTP) file can now be processed by pressing F9, the intermediary instructs.

Not everything is resolved quite yet, though. The system was paying partial episode payment (PEP) adjustment claims incorrectly, sometimes up to hundreds of dollars less per claim (see Eli's HCW, Vol. XVIII, No. 40, p. 311). The January fix has gotten the payments closer to where they should be, but not all the way.

"The PEP amounts being paid are now just pennies off from the CMS Pricer amount that you would expect," Cahaba reports on its Web site.

"Mass adjustments will be delayed until this issue is resolved."

Also: Don't be surprised if your 2010 claims paid under the physician fee schedule aren't paying yet. Medicare contractors always institute a payment hold for all the new year's claims while the system is being updated, intermediary Palmetto GBA notes on its Web site. The hold time helps contractors ensure the release is installed properly, Palmetto notes.

Usually it's a 14-day hold, but this year it will be a bit longer for physician fee schedule claims such as those for outpatient Part B therapy, Cahaba explains in a message to providers.

Why: "The President has signed the Department of Defense Appropriations Act of 2010 which provides for a ... 0% update to the 2010 Medicare Physician Fee Schedule for a two month period, January 1, 2010 through February 28, 2010," Cahaba explains in the message. The extra hold time will help contractors make sure the system is paying claims correctly.

The law that President Obama signed right before the holidays puts off a 22 percent cut for physician fee schedule Medicare rates. Observers expect lawmakers to address the physician pay cut in the larger health care reform package pending in Congress (see related story, p. 20).

• Suppliers of enteral nutrition might have a harder time arguing against competitive bidding or other payment-rate-reducing mechanisms, thanks to a new report from the OIG. In a review of Part B enteral nutrient payments during non-Part A nursing home stays in  006, the OIG found that Medicare's fee schedulez amounts for nutrients exceeded prices available to nursing home suppliers and other purchasers by more than 50 percent, according to the report at www.oig.hhs.gov/oei/reports/oei-06-07-00590.pdf.

"We recommended that [the Centers for Medicare & Medicaid Services] take steps to adjust the Medicare fee schedule amounts for enteral nutrients to more accurately reflect supplier prices," the OIG says.

In its comments on the report, CMS says it is already on the case. It plans to reduce ENT payments via bidding, which is starting this year.

• CMS may be backing down on its hardline stance regarding a new change of ownership (CHOW) rule.

In a rule that took effect Jan. 1, CMS will require new surveys for home health agencies undergoing more than one CHOW in a 36-month period. But the definition of CHOW that would trigger the survey is very wide, including small stock changes and partners departing (see Eli's HCW, Vol. XIX, No. 2, p. 10).

Now CMS tells the National Association for Home Care & Hospice that it will make exceptions for CHOWs that had new 855 forms filed by Dec. 31, according to the trade group. The agency also will consider loosening up its definition of a CHOW to better target the rule, NAHC says.

Watch for resulting clarifying guidelines, NAHC advises.

• If you're having trouble navigating the PECOS system, you're not the only one. But don't expect help from your Medicare contractor. "Providers and suppliers are experiencingvarious issues accessing and navigating the [provider, enrollment, chain, and ownership system] via the Web," acknowledges RHHI Cahaba. "CMS is aware and is actively working to resolve these issues," Cahaba promises.

In the meantime: Don't bother calling your intermediary or carrier for help with the problems. "Cahaba GBA is unable to assist with problems related to access/navigation in the PECOS Web application," the contractor says. "We ask that you refrain from calling the Provider Contact Center for assistance with this issue."

• The value of home care as a way to keep seniors in their homes is back in the news, this time as part of the PACE program.

In addition to keeping seniors where they want to live, St. Paul's Program of All-Inclusive Care for the Elderly also saves money, notes an article in the San Diego Union-Tribune. Seventy PACE programs nationwide now serve 17,000 clients, the newspaper notes. The St. Paul's program serves 105 and is looking to expand.

"The nonprofit organizations that run these programs must collect millions of dollars in reserves before they are allowed to open a care center," the Union-Tribune explains. "St. Paul's spent nine  years raising $4.2 million in reserves before launching its facility," the newspaper says.

"It's not something where you can decide one day you're going to open a PACE organization, then open up shop," CMS's Heidi Arndt told the paper. "It takes a lot of thought to develop one."

• Providers that want to avoid the lastminute rush in preparing for the transition to ICD-10 diagnosis coding can listen in to the provider call CMS held on the topic in November. The agency has now posted the call transcript on its Web site at www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp.

The call reviews how the ICD-9 codes were converted to ICD-10 codes and how to use General Equivalence Mappings (GEMs) in converting data.

• If your patients have chronic pain, you might want to flag them for falls risk attention.

Researchers are now looking at the significant role chronic pain plays in increasing risks associated with falls. A recent study, "Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population," published in the Journal of the American Medical Association, surveyed 749 adults 70 years and older to determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls among older adults living in the community.

There were 1,029 falls reported, the study notes. Among those falls, people who had two or more pain sites had higher fall rates than those that experienced no or minimal pain, according to the study's abstract notes.

• CMS has put off the deadline for requiring referring physicians' NPIs on durable medical equipment claims until April (see Eli's HCW, Vol. XVIII, No. 42, p. 327), but that doesn't mean you can ignore informational edits you receive on the topic until then.

Even if a physician's record is in PECOS, if the National Provider Identifier is not recorded, you'll get that informational error message, said CMS's Pat Peyton during a Dec. 16, 2009 CMS sponsored Open Door Forum for physicians. The weekend of Dec. 12, 2009, CMS input the NPIs of more than 230,000 practitioners into the PECOS system on providers' behalf, "so many of those informational messages should not be going out anymore," Peyton said.

Despite that large number, there are a lot more to go. Many physicians "are in Medicare but have not updated their records in six or more years, and they need to revalidate their information in order to get them into PECOS," Peyton said on the call. If they don't revalidate their info and get into PECOS, you won't be able to get paid.

Internet listing coming: CMS also intends to create an internet-based list of physicians and non-physician practitioners who can order and refer within Medicare. The listing will include the practitioners with their legal names and NPIs, Peyton said. "We still are going to do that. It's probably going to be January, but we will let you know when that is going to be there and how to access it at the appropriate time," Peyton said.

• For-profit hospice chain Odyssey Health-Care Inc. is expanding its presence in the Chicago market. The Dallas-based company has purchased Westchester, Ill.-based Generations Health-care, Odyssey says in a release. Generations has an average daily census of 55.