Home Health & Hospice Week

Intermediary probe targets dementia.

Your documentation for dementia patients better be up to snuff, or your bottom line could suffer.

Regional home health intermediary Cahaba GBA is targeting for review hospice claims with a primary diagnosis of 290.40 (Vascular dementia, uncomplicated) and a length of stay greater than 240 days, the RHHI says in an April 4 email to providers.

The intermediary is initiating the widespread probe as a result of data analysis. The review's topic code will be 5TPAJ.

Cahaba will post the probe's results when completed, it says.

• Non-profit home care providers could soon find themselves in the hot seat over their tax-exempt status. Senate Finance Committee Ranking Member Charles Grassley (R-IA) has asked the Government Accountability Office to once again examine the charity care or other community benefits non-profit hospitals are supposed to provide in exchange for their tax-exempt status. The investigation could spill over to hospitals' home care units, or even freestanding non-profit providers, observers fear.

Grassley wants to see standards for community benefits adopted. And the former committee chair is particularly concerned about executive and board member compensation, he says in his April 5 letter to the GAO. "There have been alarming reports about the lavish lifestyle that some of these individuals lead courtesy of the nonprofit hospital," the letter says.

• Iowa is the first state to win HHS approval to add home care services to its Medicaid plan, according to an HHS release. Up to now, states have had to offer home care services through waivers rather than as permanent features of their Medicaid plans.

The same law that allows the waiver change also permits states to spend money on home care services even if the beneficiary wouldn't need institutional care without them, HHS adds.

"We expect many states to follow Iowa's lead in taking advantage of the [Deficit Reduction Act's] provision which grants new freedom to state Medicaid programs and the people who depend upon them," CMS acting administrator Leslie Norwalk says in a release.

• Prepare for changes to your PS&R data. The current Provider Statistical & Reporting system won't have data for claims including dates of service after Feb. 27, RHHI Palmetto GBA explains in a Web site posting.

That's because of the nationally planned changeover of the PS&R Redesign program, Palmetto tells providers. "The PS&R Redesign program is scheduled to be released to the intermediaries and providers sometime during the summer of 2007," the RHHI says.

• A generous charity budget helped Sun-Crest Home Health Inc. win a certificate of need slot in Georgia. The state chose the Marietta, GA-based company to serve a nine-county area of Northeast Georgia, according to the Athens Banner-Herald.

SunCrest owner Barbara Rasmussen credited the victory to the fact that the company committed 5 percent of the agency's net income to indigent care through community charities, exceeding the 3 percent required by the state.

Before the CON for Barrow, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee and Ogle-thorpe counties is final, other home health agencies have a chance to appeal the decision, the newspaper notes. SunCrest competed with six other agencies for the CON.

• Medicare's prohibition on paying for infrared therapy is getting more entrenched. RHHI Associated Hospital Service, now part of National Government Services, has included the change in its revised Outpatient Physical Therapy Local Coverage Determination to reflect the Centers for Medicare & Medicaid Services' October 2006 coverage decision on Anodyne and other infrared therapy (see Eli's HCW, Vol. XV, No. 40).

• The Department of Health and Human Services created a "fictional patient" named Paul Watson for a Medicare sting operation. A medical equipment company owner claimed she could obtain a signed power wheelchair prescription for Watson from a doctor and "give her a couple of bucks."

The sting caught internist Zandrina Alexander, who appealed her health care fraud conviction because of two tape recordings that were used as evidence against her. But the U.S. Court of Appeals for the Eleventh Circuit affirmed her conviction.