Home Health & Hospice Week

Congress will take care of excess payments, CMS responds.

Add the HHS Office of Inspector General to the chorus of voices calling for Medicare to reduce home health agencies' payment rates.

When the Centers for Medicare & Medicaid Services set payment rates for the home health prospective payment system, it based the rates on "unnecessary services and other improper payments," the OIG insists in its latest Red Book, a compendium of cost-saving recommendations for Medicare and other federal programs.

The OIG disallowed "substantial unallowable costs" when it audited HHAs' cost reports for the PPS base years, but CMS didn't adjust PPS rates downward for those disallowances, the federal watchdog grouses in the report online at http://oig.hhs.gov/publications/redbook.html.

Congressionally imposed payment reductions take care of the improper costs figured into PPS, CMS says to the OIG. • House moderate and conservative Republicans continue to wrangle over whether the 2007 budget resolution will contain Medicare cuts, among other controversial items.

Like the Senate, the House Budget Committee approved a non-binding budget blueprint that did not include Medicare cuts (see Eli's HCW, Vol. XV, No. 13). But conservatives are seeking to include the cuts in the resolution passed by the entire House.

Given the inter-party discord and guaranteed opposition from Democrats, some observers wonder whether the House will pass a 2007 budget resolution at all. However, Republican party leaders say they expect passage by a slim margin. • Medicare beneficiaries enrolled in a federally approved clinical trial will qualify for broader coverage of home use of oxygen.

The Centers for Medicare & Medicaid Services announced the final national coverage determination on March 24. The CMS-approved clinical trial is sponsored by the National Heart Lung & Blood Institute.

Medicare currently covers home oxygen for beneficiaries with partial pressure measurements at or below 55 mmHg or oxygen saturation at or below 88 percent. If certain other diseases or conditions are present, Medicare coverage kicks in for patients with an oxygen partial pressure of 56 to 60 mmHg or an oxygen saturation of 89 percent.

The trial will include Medicare beneficiaries with arterial oxygen partial measurements from 56 to 65 mmHg or whose oxygen saturation is at or above 89 percent who do not meet the current Medicare coverage requirements for home oxygen.

"This is an important opportunity to improve the care of our seniors, and to get better evidence on how doctors and patients can achieve the best outcomes for this serious and hard to treat condition," says CMS Administrator Mark McClellan in a release. • CMS has updated its provider guidebook on remittance advices. The RA Guide, which includes advice on how to read RAs,  is available online at www.cms.hhs.gov/MLNProducts/downloads/RA_Guide_Full_03-22-06.pdf.

CMS will issue the guide in print and on CD-ROM later this [...]