Home Health & Hospice Week

You need to make sure your patients who are referred by their doctors know their doc is contacting you, or you'll run afoul of a new compliance clarification from the feds.

In January, the HHS Office of Inspector General reissued a fraud alert on prohibiting unsolicited telemarketing from durable medical equipment suppliers to Medicare beneficiaries. But in the alert, the OIG said suppliers couldn't call benes  even if the patients' physicians had requested that they do so.

The new twist had the supplier community up in arms, since that is the way many referrals take place (see Eli's HCW, Vol. XIX, No. 4, p. 28).

Now the Centers for Medicare & Medicaid Services is taking that new provision back --at least in part.

DME suppliers may contact beneficiaries if the physician contacts the supplier with the order -- AND the patient knows the physician is contacting you, CMS says in a set of frequently asked questions about the telemarketing alert.

Easier: The physician doesn't even have to be specific about who will be providing the DME,CMS says. "The beneficiary need only be aware that a supplier will be contacting him/her regarding the prescribed covered item, recognizing that the appropriate supplier may not have been identified at the time of consultation," according to FAQ 3.

Contact still is prohibited if the beneficiary isn't aware that her doctor will be contacting you on her behalf, CMS adds in FAQ 4.

The clarification "gives us a break on the prohibition of calling our referral patients to arrange delivery," cheers the National Association for Independent Medical Equipment Suppliers. But "use caution to be sure that you are only calling for that purpose," the trade group stresses in a message to members.

Resource: The FAQs, which also address how to handle talking to the beneficiary about other covered DME items, are online at www.cms.hhs.gov/MedicareProviderSupEnroll -- scroll down to "Downloads" and click on "DME Supplier Telemarketing Frequently Asked Questions," or e-mail editor Rebecca Johnson at www.rebeccaj@eliresearch.com with "Telemarketing FAQs" in the subject line for a free copy.

• You may need to adjust your high-therapy

claims if they fall under a newly discovered Medicare payment system glitch.

When it occurs: When you submit a home health agency claim coded for less than 20 therapy visits, but bill 20 or more visits on the claim, the system is recoding it incorrectly, reports regional home health intermediary Cahaba GBA. The system recodes the first digit of the HIPPS code correctly to a "5," but fails to recode the second, third, or fourth positions correctly.

Until a fix for the problem is in place, you'll need to adjust affected claims, Cahaba instructs. For example, for a claim coded "5AFH1" but that had 20 or more therapy visits, you need to submit an adjustment with code "5AFG1" on the 0023 revenue code line to receive correct payment.

Don't forget: "The last 8 digits of the claims-OASIS Matching Key code (Treatment Authorization Code) are used when recoding home health claims," Cahaba says in a message to providers. Make sure your code is correct to recode claims accurately.

• The new requirement for a physician narrative hasn't changed anything about the timeline for obtaining physician certification for hospice.

"Certifications may be completed up to 2 weeks before hospice care is elected," RHHI Palmetto GBA says in its Hospice Coalition Questions and Answers from its December meeting. The hospice must obtain oral or written certification by two calendar days after care is initiated.

The written cert must be on file before you bill for the care, Palmetto adds. For subsequent periods, the hospice must have the oral or written cert two calendar days after the first day of the period. Again, the written cert must be on file before submitting a claim.

• The Obama administration has finally appointed a high ranking CMS official - but it still hasn't filled the top spot of CMS Administrator.

CMS created a new No. 2 position at the agency -- principal deputy administrator -- and named former Virginia Secretary of Health and Human Resources Marilyn Tavenner to the post, according to news reports.

The move is part of a larger restructuring of the agency. Tavenner is a nurse who has held management positions at hospitals before serving in public office.

• If your chronically ill patients also suffer from anxiety, regular exercise might help them -- if they can tolerate it.

"Patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise," according to a new study by University of Georgia researchers.

The researchers examined patients participating in other studies who suffered from a variety of conditions, including heart disease, multiple sclerosis, cancer, and chronic pain from arthritis, says the study that appears in the Feb. 22 Archives of Internal Medicine.

"We found that exercise seems to work with just about everybody under most situations," study co-author Pat O'Connor, professor and co-director of the UGA Exercise Psychology Laboratory, says in a release. Exercise sessions lasting longer than 30 minutes were most helpful, the study found.

• Suppliers will need to keep closer tabs on their patients under a new edit that will take effect July 6.

Under the edit, the Medicare claims system will reject DME claims when the beneficiary was in a non-covered skilled nursing facility stay at the time the equipment was furnished, CMS says in Feb. 5 Transmittal No. 637 (CR 6695).

The Medicare DME benefit only applies in the home, CMS points out in the transmittal. "SNFs and dually-certified nursing homes (those certified for both Medicare and Medicaid) never qualify as a beneficiary's home because they provide primarily skilled care or rehabilitation services."

Watch out: The edit will take back money already paid to you if a conflicting SNF stay is later found in the system.

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R637OTN.pdf.

• Want more details about the new transfer code home health agencies must use on claims starting this summer? Then check out a new MLN Matters article CMS has issued on the topic.

CMS will eliminate source of admission codes "B" and "C" in July and replace "B" with point of origin code "47" (see Eli's HCW, Vol. XIX, No. 7, p. 51).

MLN Matters article 6757 explains how the system will treat claims for overlapping episodes.

For example: "Medicare will allow an HH RAP (TOB 322 or 332) or a no-RAP LUPA claim to overlap an existing HH episode record if the Claim Control Number (CCN) on the RAP and the episode match," the article explains.

The article is online at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6757.pdf.

• CMS made a last-minute delay to the Program Advisory and Oversight Committee (PAOC) meeting originally scheduled for Feb. 23. CMS announced the delay, which it attributed to logistical issues caused by severe winter storms in Baltimore, on Feb. 18 -- just five days before the meeting was set to take place.

The new date for the PAOC meeting is March 17, CMS says. "This postponement is necessary to ensure all interested members of the public have sufficient time to register for the meeting,"CMS says.

• Revenues are up for two national home care chains, but the same is not true for profits.

Baton Rouge, La.-based Amedisys Inc.reports net income of $38.0 million on revenues of $405.5 million for the quarter ended Dec. 31. That'sup from a $26.3 million profit on $340.1 million in revenues for the same period in 2008, says the chain with 521 HHAs and 65 hospice agencies.

Atlanta, Ga.-based Gentiva Health Services Inc. also saw revenues rise in the period, from $267.3 million in the last quarter of 2008 to $310.0 million in the most recent quarter. But the chain's net income fell from $12.8 million to $8.7 million during the period.

Gentiva recently sold off its home medical equipment, respiratory therapy, and infusion business, it notes.

• National for-profit hospice chain Odyssey HealthCare Inc. saw its profits double in the latest quarter.

The Dallas-based chain with an average daily census of 12,427 reports net income of $12.0 million on revenues of $173.4 million for the quarter ended Dec. 31. That's up from a $5.5 million profit on revenues of $167.3 million for the same time period in 2008.

Decreased workers' comp costs and lower Medicare cap costs contributed to the earnings, the company says in a release.