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Home Health & Hospice Week

Industry Notes:

Hospice COPs Could Be Out Any Day

Published on Tue Apr 19, 2005

But will the long-pending standards get pushed back once again?

Hospices will be seeing their fair share of regulatory action in the coming months, judging by the Department of Health and Human Services' new semiannual regulatory agenda.
 
The Centers for Medicare & Medicaid Services last year pledged that it would re-propose the hospice conditions of participation this month. And in the agenda published in the May 16 Federal Register, CMS still says it will issue a COP proposed rule in May.
 
Last summer a CMS official told the National Association for Home Care & Hospice that the hospice COPs would come out even earlier than May, but that did not come to pass. Chances are high that the May deadline will slip by again on the standards first proposed in 1997, experts predict.
 
CMS also expects an interim final rule in May requiring hospices to submit electronic cost reports; a final rule in November with a number of hospice amendments that already have been implemented; and a proposed rule in March 2006 establishing requirements for hospice services in long-term care facilities. 

  • Be prepared to defend your claims for your lowest-paying patients. Regional home health intermediary Cahaba GBA is starting a universal edit of HHA claims with HIPPS code HAEJ1. That's the code that corresponds to the C0F0S0 home health resource group (HHRG). Those are "patients with a low clinical severity that are also highly functional," Cahaba explains.
     
    The RHHI is launching the new edit because when it conducted a probe of 100 such claims, it found a high denial rate for patients not being homebound.     

     
  • AU contraire: durable medical equipment suppliers no longer have to include modifier AU with HCPCS code A4217.
     A Medicare change request released earlier this year removes an instruction issued last year requiring modifier AU to always be present with code A4217. Now code A4217 without modifier AU will be considered a DME code and processed accordingly. Details are at     www.cms.hhs.gov/manuals/pm_trans/R489CP.pdf.

  • CMS is starting to issue National Provider Identifier (NPI) numbers as required by HIPAA. Instructions on how to obtain the NPI, which will be used to bill all health plans, are at www.cms.hhs.gov/hipaa/hipaa2/npi_provider.asp. A new Medlearn Matters article is at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0528.pdf.

  • If you submit a paper claim to DME regional carriers, expect a denial. The Administrative Simplifi-cation Compliance Act requires suppliers to submit electronically all expenses for items and services billed to the Medicare program, CMS reminds providers. Unless they've been given a special exemption, suppliers who bill DMERCs on paper will have their claims denied. More information is online at www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp in CR 3815.

  • Are you sure you know what your software is up to? If not, you could face the fate of Miami-based Continucare Corp.
     
    The provider of home care and outpatient services has to revise overstated earnings for the last three quarters because of a software error that resulted in sending wrong data to an HMO payor, it says. The company is delaying its latest quarterly results while it confirms that it has fixed the error.

  • A DMERC is under fire from a federal judge for missing a fraud scheme involving prosthetic limbs. Palmetto GBA paid for 21,000 artificial legs and arms over a four-month period in the Miami area last year - a number that the contractor should have noticed sooner, according to a May 10 decision from U.S. District Judge Cecelia Altonaga, the Miami Herald reports. Federal prosecutors have filed a civil suit against 48 suppliers and a billing agency for allegedly submitting false claims for the equipment.
     
    Columbia, SC-based Palmetto was not included in the lawsuit, but in her decision Altonaga questioned why, according to the paper. The company maintains that catching the problem at four months in a program that relies on post-payment analysis indicates its vigilance against fraud and abuse.

  • Two former home health execs are facing civil money penalties and exclusions, the HHS Office of Inspector General reports. An administrative law judge slapped former Hawkeye Health Services Inc. president Thomas Horras with CMPs of  $711,000 and a seven-year exclusion, the OIG says. The ALJ also hit former Hawkeye director of finance Christine Richards with CMPs of $4,600 and a one-year exclusion. Auxi Health Inc. faced its own OIG settlement in 2003 related to its purchase of Hawkeye.
     
    The ALJ held that Horras included false claims, including personal expenses, on cost reports from 1995 to 1997. Richards acted with "reckless disregard" to the false claims, the OIG says.

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