Home Health & Hospice Week

It looks as though House legislators may be coming around to Senators' point of view on the SCHIP bill, and that could be very good for home care providers.

At press time, House lawmakers were indicating they would cut most or all of the Medicare provisions in the State Children's Health Insurance Program bill they passed last month. That would bring the House bill more in line with the Senate SCHIP legislation, also passed in August, which contains no Medicare provisions.

History: The House bill includes a freeze on HHApayment rates and cuts to oxygen and wheelchair reimbursement.

Don't breathe yet: Congressional insiders say separate legislation later this year will address Medicare revisions. That means home care providers will still be on the budget chopping block to pay for averting the 10 percent payment cut to physicians' Medicare payment rates, experts predict.

"It's good news for now, but we're not out of the woods yet," warns Kathy Thompson with the Visiting Nurse Associations of America. Watch for an end-of-session omnibus spending bill to contain Medicare cuts, Thompson tells Eli.

• A new report gives home health agencies a glimpse at how clients view them. Though most patients are fairly satisfied with their agency's service, agencies could improve their satisfaction scores.

Key finding: Home offices should do a better job responding to patient requests and complaints, according to the study, released Sept. 18 by Press Ganey. "The greatest source of patient dissatisfaction is not with the visit itself but dealing with the home care office on issues like changing nurses or aides and handling emergencies," concludes the report.

The study also found that Medicare patients reported the highest overall satisfaction with home care services. To view the full report, "Home Care Pulse Report: Patient Perspectives on American Health Care," go to www.pressganey.com/homecare-report.pdf.

• A few bad apples may be spoiling your Medicare reimbursement for outliers. The Centers for Medicare & Medicaid Services appears to have upped the fixed dollar loss (FDL) threshold for outliers due to fraudulent billing in Southern Florida, reports the National Association for Home Care & Hospice.

Over industry protests, CMS hiked the FDL ratio from a proposed 0.67 to 0.89 in the final rule (see Eli's HCW, Vol. XVI, No. 30). That's despite the fact that HHAs historically haven't used all of the 5 percent outlier reimbursement pool set aside under PPS.

But now outlier spending growth does appear poised to exceed the 5 percent level due to suspected abuse in South Florida, NAHC reveals. "The Program Safeguard Contractor reports more than $277 million in outlier payments for insulin-dependent diabetics in Miami-Dade, an amount which is greater than the combination of the next 10 largest metropolitan areas," the trade group says. "Dallas, for example, had only $57 million in those types of claims while having a Medicare patient population almost twice as large as Miami-Dade."

Agencies will lose as much as $200 million in outlier payments under the new FDL in 2008, NAHC estimates. CMS and other enforcement agencies are "taking aggressive steps to end" the alleged abuse. Therefore, CMS should keep the FDL ratio at current levels if not below, NAHC argues.

• Don't be surprised if you see "a large volume" of claims adjustments that aren't in your favor. Regional home health intermediary Palmetto GBA reports that it has concluded making adjustments for outliers that were paid improperly after the January 2007 pricer software implementation, according to the RHHI's Web site.

But adjustments for similarly overpaid low utilization payment adjustments (LUPAs) are still pending, Palmetto says. The overpayments occurred with non-rural LUPAor outlier claims that had dates of service spanning Jan. 1, 2007.

• It's time to start planning for National Home Care Month, which is fast approaching in November. You can also celebrate National Hospice Month and Home Care Aide Week Nov. 11-17.

For themes and ideas on how to celebrate, go to www.nahc.org/HCHPCMonth/07.

• Home care is likely to be even more in demand as America's population continues to live longer. Life expectancy for U.S. residents in 2005 reached a record high of 77.9 years, according to a preliminary report from the Centers for Disease Control's Center for Health Statistics.

"The increase in life expectancy represents a continuation of a long-running trend," the CDC says. Life expectancy has increased from 69.6 years in 1955.

• Don't expect any delays to competitive bidding if CMS Acting Administrator Kerry Weems gets his way. In his first press conference in CMS' top spot, Weems said he would prioritize the program's implementation, according to press reports.

Weems also vowed to make regulatory compliance a major focus for CMS.

• Confused about how to bill for physicians' and nurse practitioners' hospice services? Check out a handy chart from RHHI Cahaba GBA online at https://www.cahabagba.com/part_a/education_and_outreach/ educational_materials/quick_hospice_dr.pdf.

Tip: Remember to use modifier 26 and remarks when your hospice employs the doc or NP, Cahaba instructs.