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Home Health & Hospice Week

Industry Notes:

Government Rustles Up More Flu Vaccine Doses

Published on Fri Nov 05, 2004

In advance of the presidential election, the Department of Health and Human Services announced it expected to secure about an extra 6 million doses of flu vaccine for Americans.

That's another 1 million doses of the live virus vaccine FluMist, produced by MedImmune, and 5 million doses acquired from manufacturers in Canada and Germany. These foreign vaccine are acceptable, even though the government bans drug reimportation, because "we're sending our inspectors to those facilities," HHS Secretary Tommy Thompson clarified.

The addition of those vaccines should bring the total available doses to 66 million - still shy of the originally expected 100 million doses. The government expects FluMist to be used by high-priority people between the ages of 5 and 49 - many of them likely health care workers.

The Visiting Nurse Associations of America has secured 500,000 doses of the supply for its members to vaccinate high-risk patients, the trade group says. VNAA obtained the doses by working as a member of the National Influenza Vaccine Summit.

Meanwhile, HHS and the Department of Justice filed a brief Oct. 22 supporting a Florida lawsuit against Fort Lauderdale, FL-based Meds-Stat for price gouging. Prosecutors accuse Meds-Stat of selling a flu vaccine vial for $900. Meds-Stat argued in court it wasn't price gouging, reports the South Florida Sun-Sentinel.

And New Jersey passed a bill implementing a $500 fine each time providers vaccinate people not in the high-risk category, press report say.

Finally the Victoria Clipper ferry, which had been transporting people from Seattle to Victoria, British Columbia, to receive flu vaccinations, ended the practice, saying it was "irresponsible," according to press reports.

  • Two home care powerhouses have reported their earnings for the most recent quarter, with mixed results. Baton Rouge, LA-based Amedisys Inc. had a 58 percent surge in revenues for the quarter ended Sept. 30, to $58.5 million. And its net income skyrocketed 117 percent over the same quarter last year, to $5.2 million.

    Amedisys' admissions grew 30 percent over last year's quarter, and the company is opening 12 new locations in 2004. Amedisys plans 15 new locations next year.

    Melville, NY-based Gentiva Health Services Inc., on the other hand, reported net income and revenues that fell a bit from last year's quarter. Gentiva's net income for the quarter ended Sept. 26 was $4.4 million on $198.1 million in revenues, compared to a $4.5 million profit on $199.7 million in revenues for the same period in 2003.

    Expected revenue declines from CIGNA Healthcare and local government business led to the sagging numbers, even though Medicare business grew, Gentiva says. Another culprit: the hurricanes that rocked Florida during the quarter. Due to storm-related costs, Gentiva has lowered its earnings expectations for 2004.

  • The Centers for Medicare & Medicaid Services has relented on reimbursement for new wheelchair cushion codes (see Eli's HCW, Vol. XIII, No. 37, p. 295).

    Allowable fees for wheelchair custom-molded seats and backs (HCPCS codes K0658 and K0666) have been changed to reimbursement under individual consideration, the statistical analysis durable medical equipment regional carrier medical director told attendees of the recent MedTrade conference, according to the American Association for Homecare. The change will be retroactive to Oct. 1, the SADMERC official said.

  • New Hampshire home health agencies aren't happy that CMS has failed to agree to leave four southern NH counties in the Boston metropolitan statistical area for wage index purposes, the Home Care Association of New Hampshire reports. HHAs had asked for the reclassification in response to the prospective payment system proposed rule.

    But in its final PPS rule, CMS declined to offer reclassification or other protections against drastic wage index swings to HHAs (see Eli's HCW, Vol. XIII, No. 38, p. 298). That's in stark contrast to hospitals, which received one-year transition periods for moving from one MSA to another, or three-year transition periods for moving from an MSA to rural designation, HCANH notes.

  • Providers and beneficiaries should get more information on Medicare denials soon. By next April, intermediaries and carriers should automatically specify which local coverage determination (LCD) they used to deny a claim (if applicable) when they send a notice of denial, CMS says in Change Request 3363.

  • The National Association for Home Care & Hospice is questioning CMS' choices for Qualified Independent Contractors, which will furnish a new level of appeals for HHAs under Medicare appeals reform (see Eli's HCW, Vol. XIII, No. 38, p. 303).

    CMS has chosen some Program Safeguard Contractors to fulfill QIC roles. That could compromise the QICs' supposed independence in adjudicating claims appeals, because as PSCs they could deny some of the claims they'd later be reviewing as QICs, NAHC warns.

  • Providers have to use only the most recent, HIPAA-compliant version of free Medicare billing software, warns DMERC CIGNA Healthcare. "Effective March 1, 2005 CIGNA DMERC will only support the most current version of the Free Billing Software," it says - as will other contractors.

  • Keep a close eye on your employees for billing fraud. Tallahassee, FL therapist Jennifer Newcomb, an employee of Children First Home Health Care Service, recently was arrested and charged with seven counts of Medicaid fraud and wrongful billings, announced Florida Attorney General Charlie Crist.

    "Between June and November 2003, New-comb allegedly submitted 44 claims for 41.25 hours of undelivered physical therapy, costing the State of Florida $1,777," Crist's announcement says. If convicted, Newcomb could face up to five years in prison and $35,000 in fines. Children First has not been implicated in the case.

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