Home Health & Hospice Week

Conclusions clash with earlier independent analysis, providers say.

A new federal report fuels claims that Medicare overpays providers of home oxygen equipment.

The report from the HHS Office of Inspector General, released Sept. 13, sent the stocks of companies including Lincare Holdings down and garnered quick reaction from industry representatives.

The Council for Quality Respiratory Care (CQRC), a coalition of the nation's 11 leading home oxygen therapy provider and manufacturing companies, was among the first to challenge the OIG cost study findings, citing the study's limited scope, small sample selection, and failure to consider critical patient services in the provision of quality home oxygen care.

A 2006 study by Morrison Informatics analyzed data from 74 companies that provide home oxygen therapy to more than 600,000 Medicare beneficiaries (see Eli's Home Care Week, Vol. 15, No. 24).

That study showed that nearly three-quarters (72 percent) of the cost of providing home oxygen therapy falls under the scope of patient care and services, not equipment, says the CQRC.

"Many of these types of services were not accounted for in the OIG's survey document," the group said in a news release.

"We were stunned at the narrow sample size of the [OIG] report, which covered only 150 Medicare beneficiaries and simply failed to recognize a multitude of critical patient services provided with home oxygen therapy," said Peter Kelly, chairman of CQRC and CEO of Pacific Pulmonary, in a news release.

Medicare's policy for the provision of home oxygen has gone through numerous changes, including cuts that are scheduled to take effect over the next three years.

The policy changes that are in the works are competitive bidding, which will mandate a specified set of services, and implementation of the 36-month cap with equipment ownership requirements, as outlined in the Deficit Reduction Act of 2005.

• Concerns about the local coverage determination affecting power mobility devices prompted the Rehab and Assistive Technology Council (RATC) of the American Association for Home Care to send a letter earlier this month to Department of Health and Human Services Secretary Mike Leavitt and CMS Administrator Mark McClellan. The letter outlines the council's concerns about the LCD and the October 2006 implementation timeframe.

"We believe the policy as currently written contains significant health and safety concerns and we strongly recommend that CMS postpone implementation until these concerns are addressed and a revised LCD is issued that ensures access to medically appropriate equipment," the letter states.

U.S. Senators Rick Santorum and Arlen Specter and Congressman Don Sherwood have also sent letters to CMS and the U.S. Department of Health and Human Services expressing their support for a postponing the October 1implementation of the LCD, reports AAHomecare.

The goal: provide time to address the health and safety concerns and to ensure that appropriate methodology is used when calculating the new power mobility device fee schedules for the codes.

• Be ready to implement coding changes Oct. 1. Updated 2007 ICD-9-CM codes take effect with no grace period. The 2007 list of new codes includes 22 new neurological and one new orthopedic case mix diagnosis codes.

To do: Be sure you have new 2007 coding manuals, updated any 'cheat sheets" your staff uses, and educate all staff who will need to deal with the coding changes.

Identify current patients who have one of the changed diagnostic codes and be prepared to update the code on the next OASIS assessment or plan of care developed after Oct. 1, recommends Chapel Hill, NC consultant Judy Adams with LarsonAllen.

Note: Look for more information in Eli's Home Health ICD-9 Alert, available at www.elihealthcare.com or by calling 1-800-874-9180.

For a complete discussion of new coding changes, tap into the teleconference, "2007 ICD-9 Coding Update for Home Health" at http://codinginstitute.com/conference/tapes.cgi?detail=642 or by calling 1-800-508-2582.

• A South Florida physician was sentenced last month to nearly four years in prison for her role in a $2.3 million durable medical equipment (DME)-related Medicaid kickback scheme, prosecutors in Florida announced.

In addition to the 46-month term, defendant Zabdy Westerburger also was ordered to pay restitution of more than $2.3 million, said R. Alexander Acosta, U.S. attorney for the Southern District of Florida, in a written statement.

According to the statement, Westerburger provided bogus prescriptions in return for cash kickbacks from owners of DME companies who would bring individuals to her office and specify medical equipment and medications to prescribe, the statement said.

To date, at least 30 people have been convicted in connection with the scheme, the federal prosecutor states.

• Look for education from the Centers for Medicare & Medicaid Services regarding their latest antifraud effort. The agency announced this month that they will contract with a number of entities to offer education and communication with the provider community regarding the new "Comprehensive Medicaid Integrity Program." (To learn more, see Eli's Home Care Week, Vol 15, No. 29.)

The contractors will also perform audits and collect overpayments, says CMS.

At a recent Special Open Door Forum on the topic, CMS Program Integrity staff said the vast majority of providers are honest and that the program will be directed at the small percentage of those who are not.

But the American Association for Homecare has expressed these concerns about the new anti-fraud effort: the lack of standardization among state Medicaid program policies and procedures; the need for education of providers to address ambiguity in program guidelines; and inaction on the part of CMS when providers attempt to bring suspected fraud to the government's attention.

• Make sure your electronic system is fully HIPAA compliant. Starting Oct. 1, CMS will transmit only HIPAA-compliant electronic remittance advice transactions to providers who are accepting the electronic transactions, Medicare contractors report.

A contingency program has been in place since the official deadline for HIPAA-compliant financial transactions passed in Oct. 2003, when CMS realized most of the healthcare industry was not going to meet the deadline. CMS ended the contingency plan for non-compliant claims last October and is following it this year with an end to its practice of sending out compliant and non-compliant remittance advices.

• Check out the pandemic influenza preparedness checklist for home health agencies at www.pandemicflu.gov/plan/healthcare.html.

The work of the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention, the checklist is designed to help public and private organizations that provide home health care services assess and improve their preparedness for responding to pandemic influenza.

"Home health agencies will likely be called upon to provide care for patients who do not require hospitalization for pandemic influenza, or for whom hospitalization is not an option because hospitals have reached their capacity to admit patients," cautions the CDC.

• Sunrise Senior Living. has acquired Trinity Hospice, the eighth largest provider of hospice services in the United States.
Trinity, now a wholly-owned subsidiary of Sunrise, is headquartered in Dallas, TX and currently operates 24 hospice programs in nine states (Arizona, Louisiana, Kansas, Missouri, Mississippi, Oklahoma, Pennsylvania, Tennessee and Texas).

Dino Eliopoulos, formerly Trinity's chief operating officer and CFO, has been appointed president of the company.