Home Health & Hospice Week

You could be using the new assessment within 18 months.

An even newer version of the changes to the OASIS dataset is out and open for comment.

The Centers for Medicare & Medicaid Services released a new version of the OASIS-C in the Oct. 19 Federal Register. (The current OASIS version in use is OASIS-B1).

Back in July CMS released its first version of the significantly revamped OASIS document. The changes include the addition of 30 process-based measures on items like vaccinations and prevention programs (see Eli's HCW, Vol. XVI, No. 28).

"When these things get posted, please look at them and comment," urged CMS' Pat Sevast at the OASIS Certificate and Competency Board's first annual conference in Baltimore Nov. 12. Sevast exhibited a seven-page list of changes made between the first and second versions.

The latest version released Oct. 19 is available at www.cms.hhs.gov/PaperworkReductionActof1995 --search for CMS-10238 and disregard the 7/27/2007 date listed on the initial page.

But if you haven't commented yet, it may be too late for this round's feedback, which is due Nov. 19 at 5 pm. CMS hopes to implement the new OASIS in mid-2009, Sevast said.

• The feds are getting an earful about the shortcomings of a recent report comparing Medicare reimbursement for power wheelchairs to the prices charged by Internet-based suppliers.

The report (OEI-04-07-00160) was released by the Office of Inspector General this month (see Eli's HCW, Vol. XVI, No. 39).

The American Association for Homecare joined the Power Mobility Coalition and others in condemning the report for comparing "apples to oranges."

"We firmly maintain that the cost of acquiring power wheelchairs used by Medicare beneficiaries through the Internet does not in any way compare to the cost of providing these devices to Medicare beneficiaries adhering to the appropriate standards of care," said AAHomecare president Tyler Wilson in letters to the OIG's Daniel Levinson and Pete Stark (D-CA), who chairs the House Ways & Means Committee's Subcom-mittee on Health.

• Members of Congress continue to hammer away at a Medicare legislative package for 2008, and that's leaving home care providers very nervous.
 
Representatives from the National Association for Home Care & Hospice and various state trade groups as well as providers lobbied both Houses of Congress on Nov. 9. They urged avoiding home care cuts and averting the 2.75 percent cut due to supposed case mix creep next year.

A number of home health agencies pleaded their case before congressional staffers, giving examples of the harm done by the coming cut, NAHC reports.

Carolina East Home Care & Hospice will have $289 less per patient in Medicare reimbursement under 2008 rates compared to this year, director Lynn Hardy told separate House and Senate briefings. And the Visiting Nurse Association of Southeastern Massachusetts would be operating at a $2 million deficit by 2011 under the creep cut, CEO Cynthia Cardoza said.

The Senate Finance Committee, meanwhile, can't seem to agree on whether it wants a one-year or two-year "fix" for physicians' payments. Without intervening legislation, physicians will see a 10.1 percent drop in Medicare payment rates next year.
 
The Committee is considering paying for the fix with Medicare managed care plan payment cuts, but Republicans are pushing hard to minimize cuts to plans. That will leave legislators searching for more budget-cutting targets, with home care providers a popular place to look.

• HHAs can expect CMS to issue HAVEN software by mid-December, said CMS' Pat Sevast in a session at the OCCB's conference in Baltimore.

CMS is testing the new version now. The agency won't release the software any earlier because some providers always begin using it too early, Sevast explained. But agencies will have to download the software, since the agency will no longer provide CDs, she related. You can access the software when you sign into the system to transmit your OASIS data, she instructed.

• HHAs interested in participating in the seven-state pay for performance demonstration project have only until Nov. 30 to enroll, Abt Associates' Henry Goldberg said at the OASIS Certificate & Competency Board conference in Baltimore Nov. 12. Only "a handful" of HHAs had enrolled so far, but the P4P demo invitation letters had just gone out, Goldberg noted.

• May 23 appears to be back on as the deadline for you to use the National Provider Identifier for referring physicians on your Medicare claims. "When an identifier is reported on a claim for ordering/referring provider ... that identifier must be an NPI" as of that date, CMS says in Oct. 26 Transmittal 225 (CR 5674).

"Providers who have not obtained an NPI by May 23, 2008, are not permitted to refer/order services or items for Medicare beneficiaries," regional home health intermediary Associated Hospital Service says in a Nov. 6 message to providers.

The transmittal is at www.cms.hhs.gov/Transmittals/downloads/R225PI.pdf.

• Hospices should beware of a new claims requirement hitting Jan. 1. No hospice provider should report a V code as a primary diagnosis for Medicare beneficiaries for any date of service on or after Jan. 1. If you do, the claim will be rejected based on systems changes related to the new reporting requirements.

"Hospices must ensure they cease reporting V-codes as a beneficiary's principal diagnosis for Jan. 1, 2008 dates of service whether or not they exercise their option to report additional service data," instructs CMS in Transmittal 1304 at www.cms.hhs.gov/Transmittals/2007Trans/list.asp.

• The final rule for Medicare physician payment carries more than a 10 percent cut to physician home care services such as certification and care plan oversight. It also lists a 2008 therapy cap of $1,810 for physical therapy and speech language pathology combined and $1,810 for occupational therapy. Those caps apply only to Part B therapy, not therapy furnished to patients under the home care benefit.

And the rule allocates more work RVUs for physician home visits (99343-99350) and domiciliary/rest home visits (99326-99337) than proposed. Docs who commented on the proposed rule asked for higher RVUs than the Relative Value Update Committee (RUC) had recommended, and CMS split the difference.

Example: New patient home visit code 99343 had a RUC recommendation of 2.27 work RVUs, but commenters asked for work RVUs of 2.65. So CMS ended up giving the code 2.53 work RVUs.

• In addition to being National Home Care & Hospice Month, November is also American Diabetes Month. About 10.3 million people age 60 and older have diabetes, CMS reminds providers.

More information about the month is at www.diabetes.org/communityprograms-and-localevents/americandiabetesmonth.jsp. Providers can ob-tain Spanish-language information on diabetes from the National Institutes of Health at http://diabetes.niddk.nih.gov/index_sp.htm.

And November is COPD Awareness Month as well. Twelve million Americans have been diagnosed with Chronic Obstructive Pulmonary Disease and another 12 million may have it and not know it, says the National Institutes of Health's National Heart, Lung and Blood Institute in a release. More information is at www.LearnAboutCOPD.org.