Home Health & Hospice Week

Reach out to your representatives today, trade groups urge.

Home care providers are hopeful that Pres-ident-elect Barack Obama will make Medicare a kinder place for home care, and they're ready to work on it.

In a last-minute campaign stop in his campaign office in Charlotte, N.C., on Nov. 3, Obama addressed the issue of home care when making calls to uncommitted voters. "This is happening in my own family, and in addition to Social Security and Medicare one of the things that I think is really important is [utilizing] home care a lot more," Obama told a caller who broached the topic, according to Time magazine. "My grandmother was able to stay [at] home all the way until recently." Obama's grandmother died on Nov. 2 after a long illness.

"The good news for the home care and hospice community is that he has pledged his support for greater access to home care services," notes the National Association for Home Care & Hospice in its newsletter for members.

"I hope that a new administration ... will have a broader vision of the issues in Medicare," Bob Wardwell with the Visiting Nurse Associa-tions of America tells Eli. In the big picture, home care should be "recognized as a key part of the solution to the graying of America, rather than a budget item that is somehow a problem that gets solved through across-the-board cuts," says Wardwell, a former CMS official.

"I know VNAA is ready to make the case for non-profit home care as soon as the new administration is seeing visitors," Wardwell adds.

NAHC "pledges to work with [the president] on health care reform and other initiatives to encourage greater use of home- and community-based care," it says.

The new administration appoints the leaders of the Department of Health and Human Services and the Centers for Medicare & Medicaid Ser-vices, points out the National Association of Inde-pendent Medical Suppliers in a message to members. "We have new opportunities to advance the agenda of DME," the trade group observes.

And don't forget your local representatives. "We must begin building relationships with the new Congress," NAIMES urges. "We must help the new and expanded Democratic majority understand who we are, what we do, and how good we are."

"NAHC will aggressively make the case in the remaining days of the 110th and next year in the newly elected 111th Congress for reinstatement of the home health rural add on," the trade group adds.

• CMS has finally issued its rule on post-oxygen cap payment and suppliers aren't happy. The guidance is "alarming and wholly inadequate," blasts the American Association for Homecare.

The policy is "a disaster," declares NAIMES. Troublesome provisions include inadequate payment for maintenance and service visits after the cap elapses, no payments for emergency services, and being responsible for patients who move to different locations after the 36-month cap, AAHomecare points out.

• The newly announced Recovery Audit Contractors may soon make your life harder. "Health care providers that might be reviewed include ... home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B," CMS warns in a release about the new permanent contractors.

CMS made the RAC program permanent this year after an earlier pilot program in three states recovered $372 million.

But pilot state providers complain that unqualified RAC personnel made coverage determinations and that the contractors have improper incentives to deny or downcode claims. RACs are tantamount to bounty hunters due to their contingency fee payment methodology, they contend.

The four new RACs are Diversified Collec-tion Services of Livermore, Calif., in Region A, CGI Technologies and Solutions of Fairfax, Va., in Region B, Connolly Consulting Associates of Wil-ton, Conn., in Region C, and HealthDataInsights of Las Vegas in Region D. RAC review will expand nationwide by next year.

On hold: CMS has put the RACs' work temporarily on hold while two unsuccessful bidders protest the contract awards. The Government Acc-ountability Office will make a decision on the protest within 100 days and RAC work will resume, CMS says.

CMS is holding two calls about the new RAC program, one for Part A providers on Nov. 12 and one for Part B providers on Nov. 13. Dial-in information is online at http://www.cms.hhs.gov/OpendoorForums/05_ODF_SpecialODF.asp.

More information on RACs, including the new contractors' jurisdictions and implementation schedules, is at http://www.cms.hhs.gov/RAC.

• You have until Nov. 22 to give your two cents on CMS's next phase of hospice claims data reporting. CMS's proposal may alleviate hospices' concerns about current data collection, but also create more work for providers.

CMS wants to collect hospice visit data in 15-minute increments for six disciplines including nursing, aides, social work, and three therapies. That would require line-item billing, CMS says in its proposal at http://www.cms.hhs.gov/center/hospice.asp.

Big relief: CMS also wants to include social worker calls to family members in the visit data, also in 15-minute increments.

• If you're frustrated by the documentation physicians submit to support your wheelchair claims, you may get some help from the durable medical equipment Medicare administrative contractors. "Power mobility devices ... continue to be a major medical review focus for the DME MACs," intermediary Cahaba GBA points out in a message to providers. "Documentation by physicians of the statutorily required mobility assessment is often incomplete."

Documentation forms recommended by "certain high volume power wheelchair suppliers" often aren't sufficient, Cahaba warns. Instead, the intermediary recommends sharing with docs a three-page letter generated by the DMACs.

Resource: The letter reviews the eligibility and documentation requirements to support PMD claims. Email editor Rebecca Johnson at rebeccaj@eliresearch.com with "DMAC Physician Letter" in the subject line to receive a free copy of the letter.

• The American Health Information Man-agement Association continues to lobby for quick implementation of the ICD-10 coding system, as CMS has proposed.

Heavy-hitting provider organizations have urged CMS to postpone ICD-10 implementation, but AHIMA thinks it should stay on track for its 2011 debut. "The time for moving forward is long overdue," AHIMA says in an Oct. 28 letter to legislators. "If we do not move forward with implementation now, vendors and users will continue to build and buy products -- including electronic health records systems -- that cannot handle the upgraded ICD-10-CM and ICD-10-PCS coding system. Those systems will be much more expensive to modify and retrofit in the future."

• Don't forget to send in your list of hospice patients to Cahaba GBA by Nov. 30. The intermediary will use the listing to calculate your 2008 per beneficiary cap for Medicare.

The list should comprise "Medicare beneficiaries who filed an initial election to receive hospice care beginning September 28, 2007 through September 27, 2008," Cahaba instructs in a message to providers. "Please remember a beneficiary cannot be counted more than once and cannot have been counted previously in either another hospice provider's cap or another reporting year."

Tip: If you've been certified less than a year, you are exempt from the listing requirement.

• You'd better make sure your employees are adequately trained, or your bottom line -- and your reputation -- could suffer. One Seattle home health agency has learned that lesson the hard way.

The city of Seattle and HHA Millennia Healthcare have paid $600,000 to settle a lawsuit from a patient who developed life-threatening bedsores when her aide didn't reposition her frequently, reports KING 5 News. The city paid for the care.

The aide in the case said no one had trained her on how to deal with pressure ulcers. The patient spent two months in the hospital for treatment of the bedsores, which were infected with MRSA. The city settled to avoid a trial, it told KING 5 News.

• The U.S. economy may look bleak, but the same isn't true for home care.

That's no surprise, considering that health care in general is considered a recession-resistant industry. "With an aging population and the largest health care spending in the world, the nation's medical sector could fare perhaps best of all" in the recession, the Minneapolis Star Tribune reports.

"People get sick and need medical care regardless of the state of the economy," Standard and Poor's David Wyss told the newspaper.

Gentiva and LHC Group are two examples of home care companies thriving in the current economy. National chain Gentiva Health Services Inc. reported net income of $120.9 million for the quarter ended Sept. 28 compared to $8.2 million for the year-ago quarter. Even netting out the $107.9 million Gentiva received for selling a 69 percent interest in its managed care CareCentrix unit, it's still a gain. The Melville, N.Y.-based company reported net income of $347.6 million for the quarter compared to $309.1 million for the same period last year.

LHC Group Inc. reported net income of $8.0 million on revenues of $98.2 million for the quarter ended Sept. 30. That compares to a $6.0 million profit on $77.5 million in revenues for the same period in 2007.