Home Health & Hospice Week

Providers wanting to brush up on vaccination billing procedures before the season starts can consult two new transmittals from the Centers for Medicare & Medicaid Services.

The agency outlines the difference between mass immunization roster billers and centralized billers, among other specifics, in Aug. 15 Transmit-tal No. 366 (CR 6121).

Reminder: Beneficiaries do not need to have a physician's order or supervision to receive a Medicare-covered vaccination, points out the transmittal at http://www.cms.hhs.gov/transmittals/downloads/R366OTN.pdf. A related MLN Matters article is at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6121.pdf.

And CMS spells out vaccination billing changes to the Medicare Claims Processing Manual in a 56-page Sept. 5 transmittal.

For example: Roster bills do not require a National Provider Identifier (NPI), CMS says in Transmittal No. 1586 (CR 6079), at www.cms.hhs. gov/transmittals/downloads/R1586CP.pdf.

Meanwhile, the Visiting Nurse Associa-tions of America is helping the public find places to get flu vaccinations. Interested persons can search for a flu clinic near them at www.vnaa.org.

Last year, VNAA member agencies conducted over 4,500 flu clinics, the trade group notes.

• If you're still waiting on payment for DME items in the 10 former competitive bidding areas, you may soon see relief. CMS has issued the formal instructions telling DME MACs to pay for former bid items under fee-for-service rules.

"Restore all standard fee-for-service (FFS) edits and payment files that were in effect for DMEPOS claims as of June 30, 2008," CMS instructs the carriers in Sept. 5 Transmittal No. 375 (CR 6203).

Contractors should reprocess denied and underpaid claims by Sept. 30, CMS says.

Don't overlook: Home health agencies will have to resubmit claims that were denied due to competitive bidding, CMS instructs.

The payment date for held claims is less clear. "Contractors shall process all previously-held DMEPOS Competitive Bidding Program claims under standard FFS rules and shall complete such processing as soon as possible," CMS says.

Not over yet: CMS directs carriers to hold onto their bidding programming even though they're disabling it. That will "permit the resumption of the DMEPOS Competitive Bidding Program with a minimum of additional reprogramming, upon notification," the agency notes.

The transmittal is online at http://www.cms.hhs.gov/transmittals/downloads/R375OTN.pdf.

• There's yet another HH PPS Pricer problem, although this one affects your bookkeeping more than your reimbursement.

Affected claims process with the correct reimbursement, but "the Fiscal Intermediary Stan-dard System (FISS) does not show the new Health Insurance Prospective Payment System (HIPPS) code assigned by Pricer," RHHI Cahaba GBA says in a Sept. 9 message to providers. The problem af-fects claims with dates of service Jan. 1 or later.

• The topic of home care is proving important to some politicians this election year. On Sept. 9, Presidential hopeful Barack Obama (D) made a campaign stop in Bristol, VA. He dropped by the town's old-fashioned soda shop and discussed increasing home care with shop owner Doug Ellis, reports the Bristol Herald Courier. "Both agreed it was a good idea," the newspaper said.

In Oregon, Sen. Gordon Smith (R) has run TV ads accusing challenger Jeff Merkley (D) of cutting $4 million from a state program that furnishes home care to seniors.

The Merkley campaign says the state lawmaker merely reduced an increase to Oregon Project Independence, and didn't cut the program's budget, according to the Associated Press.

In Washington state, an initiative that would require home care workers to pass a certification exam, complete more training and undergo background checks will be on the Nov. 2 ballot, AP says. The Service Employees International Union is a supporter of the initiative.

Opponents wanted the initiative thrown out because of "a major misprint on the petitions that voters signed," AP says.

• Palmetto GBA has revised some local coverage determinations (LCDs) to include the Karnofsky Scale. Palmetto added the scale citation to LCDs for Hospice The Adult Failure to Thrive Syndrome (RHHI LCD 00AH-001-L) and Hospice HIV Disease (RHHI LCD 97AH-008-M), the intermediary says in an email to providers.

• Some physicians may be exempted from the durable medical equipment accreditation requirements that will take effect in September 2009, but Federally Qualified Health Clinics won't be. So says CMS in a question-and-answer issued after its Sept. 3 special Open Door Forum on DME accreditation.

"All FQHC's would need to have a DMEPOS supplier number in order to bill for those separately, and go through the same process as any other DME supplier," CMS says.

More information about DME accreditation and quality standards is online at http://www.cms.hhs.gov/medicareprovidersupenroll.

• National chain Amedisys Inc. plans to buy six HHAs from Home Health Corp. of Amer-ica. Two agencies each are in Pennsylvania, Mary-land and Delaware, the Baton Rouge, LA-based company says in a release.

"This acquisition will expand the Com-pany's coverage to five new counties in Maryland, a Certificate of Need state, five new counties in Pennsylvania and provide state-wide coverage in Delaware," Amedisys crows in the release. Annual revenues for the agencies combined is $23 million.

• Nursing home company Sun Healthcare Group Inc. and its SolAmor Hospice Corp. division has acquired Holisticare Hospice of New Jersey, the Irvine, CA-based company says. Sun bought the hospice for $7.7 million, according to a release. SolAmor furnishes hospice services in six states with annual revenues of $22 million.

• Another clinical study may increase demand for CPAPs. Adults with refractory partial epilepsy and obstructive sleep apnea have a reduction in seizure activity if their OSA is managed with continuous positive airway pressure at night, according to a new study from Vanderbilt University in Nashville, TN. "A 50 percent or greater reduction in seizures was observed in 28 percent of the subjects in the therapeutic group [using CPAPs] as compared to 15 percent of those in the sham group," the researchers said in a study published in the most recent issue of Neurology.