Home Health & Hospice Week
HOME CARE BUDGETS SUFFER DESPITE STIMULUS FUNDING
States tighten belts and providers will have to follow suit. Many states are crunching the numbers and realizing they still must make cuts in these lean economic times to balance the budget. For example: New York plans to reduce spending on home care services by $68 million in its next budget, notes the Buffalo News. And California will cut millions from its In-Home Supportive Services program because the state won't receive the full $10 billion in stimulus funding it first expected, reports The (Stockton) Record. • The Centers for Medicare & Medicaid Services has included a new section on hospice caps and appeals in the Medicare Claims Processing Manual. New section 80.3 in Chapter 11 of Internet Only Manual 100-4 spells out contractors' requirements regarding hospice caps. Intermediaries must send each hospice a letter with the year's cap calculation and any overpayment due, if applicable, the new section specifies.Contractors must send the letter even if the hospice doesn't have a cap overpayment. The letter will also inform hospices that they can appeal to either the contractor or the Provider Reimbursement Review Board, depending on the amount in controversy, within 180 days of the letter. More information is in April 3 Transmittal No. 1708 (CR 6400) online at www.cms.hhs.gov/transmittals/downloads/R1708CP.pdf. • CMS is encouraging Medicare providers to use the Internet-based Provider Enrollment,Chain and Ownership System (PECOS) to cut their enrollment paperwork time in half, but DME suppliers can't take advantage of the option. "By submitting an initial Medicare enrollment application through Internet-based PECOS, a provider or supplier organization's enrollment application can be processed as much as 50 percent faster than by paper," CMS stresses in a release. "This means that it will take less time to enroll or make a change in an existing enrollment record." However, "Internet-based PECOS will not be available to suppliers of durable medical equipment, prosthetics, orthotics, and supplies until a future date," CMS says on its PECOS Web site. • You may have to resubmit claims for diabetes self-management training (DSMT), thanks to a claims system glitch. Beneficiaries are eligible to receive 10 hours of DSMT in an initial year after being diagnosed with diabetes, then two hours per year after that. But a system error has been rejecting claims as if the beneficiary already used up the initial year's 10 hours, says contractor National Government Services in an e-mail to providers. The problem should be fixed this month, allowing providers to resubmit claims successfully, NGS expects. • To avoid claims denials, you may want to look at a newly revised local coverage decision (LCD) from regional home health intermediary Palmetto GBA regarding Home Health Psych Care. In the LCD changes that took effect March 26, Palmetto added 30 new diagnosis codes that support medical necessity. Palmetto also added this language under the documentation requirements section:"The person rendering the services must sign each visit note. If psychiatric services were rendered it must have been performed by a psychiatric RN, and their resume must have been reviewed and approved by Palmetto GBA." The revised LCD is at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=265&lcd_version=38. • If you're billing for injectable medications and/or services supporting them, you'd better make sure your documentation makes the grade. "The use of injectable medications when an oral form of the same medication is available must meet medical necessity requirements for use of the drug, and for the route of administration," NGS says in an article on its Web site. "Documentation should indicate that the patient was unable to tolerate the oral preparation prior to initiation of the intravenous form of the medication," the RHHI instructs. This is a national policy from CMS, not a local coverage determination, NGS adds. More information is online at www.ngsmedicare.com/NGSMedicare/RHHI/EducationandSupport/ToolsandMaterials/OralVersusIVMedications.pdf. • If you're wondering what life will be like under new Medicare Administrative Contractor National Health Insurance Corp. when it takes over from NGS in May, you may want to tune in to some home care-specific teleconferences from the new MAC. NHIC will host a home health and hospice open doorApril 15 and a home health billing session April 23. It also will host sessions about the transition. More information about NHIC's educational programs is at www.medicarenhic.com/J14_prov/j14_edprograms-PartA.shtml. • Providers may have to wait a little while longer before a permanent CMS head is named. HHS Secretary nominee, former Gov. Kathleen Sebelius (D-Kan.), was well received in an April 2 Senate Finance Committee confirmation hearing. Sebelius made home care-positive remarks at the hearing about rebalancing long-term care to encourage cost-effective home care services, notes the National Association for Home Care & Hospice. But a full Senate confirmation vote isn't likely until the end of the month, observers predict. • The home medical equipment industry has stepped up its campaign against the new incarnation of competitive bidding, with the revised bidding rule's implementation date looming April 18. Take action: Suppliers should ask their members of Congress to rescind the rule, the American Association for Homecare urges. "If this rule is finalized, quality patient care will be sacrificed and thousands of businesses already suffering under an economic recession will be forced to close their doors," says John Shirvinsky of the Pennsylvania Association of Medical Suppliers. PAMS held an "HME Survival Summit"earlier this month. "Competitive bidding is a flawed policy that does not take the beneficiary into account," U.S.Rep. Jason Altmire (D-Penn.) told suppliers in his address at the Summit. "Medicare's so-called 'competitive' bidding program is actually an anti-competitive scheme,"PAMS blasts in a release. HME spending has grown only 0.75 percent a year and represents only 1.6 percent of the Medicare budget, PAMS adds. • If you are sticking your head in the sand over the new Red Flags Rule from the Federal Trade Commission, you may be very sorry. "The FTC's interpretation of the Red Flags Rule provides an extremely broad definition for these terms," law firm Sidley Austin warns in a regulatory update about the new rule that takes effect next month."Health care providers routinely bill patients and others in arrears, and therefore could meet the definition of 'creditor' under the Red Flags Rule." The FTC's interpretation "could create significant compliance issues not only for smaller health care providers, but also for larger health care providers," the firm cautions. (More information on the rule is in Eli's HCW, Vol. XVIII, No. 10, p. 77. See a future issue of Eli's HCW for tips on how to tailor your Red Flags Rule plan to the home care environment). • Home health agencies have a new tool in their fight against Medicare cuts this year. A new "Help Us Choose Home" campaign taking aim at President Obama's and the Medicare Payment Advisory Commission's proposed HHA cuts has been funded by the National Association for Home Care & Hospice and orchestrated by Pennsylvania PR firm Neiman Group. The campaign includes a Web site, helpuschoosehome.com, that contains industry information, stats, and patient testimonials. • The poor economy may have a silver lining for you -- an easier time finding staff. Due to the economic crisis, many nurses are returning to work or putting off retirement, reports the Washington Post. That means most hospitals are reporting few to no openings. Don't expect the climate to last long,though. As soon as the economy rebounds, the nursing shortage will return to critical, experts say.
Home Health & Hospice Week
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HOME CARE BUDGETS SUFFER DESPITE STIMULUS FUNDING
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