Home Health & Hospice Week

Be prepared to defend your inpatient claims with care intensity documentation.

If you've been billing for a hospice general inpatient day when your patients' caregiver support fails, you'll have to change your ways--and receive a lot less reimbursement.

Hospices may bill Medicare for a general inpatient day only when beneficiaries require "an intensity of care directed towards pain control and symptom management that cannot be managed in any other setting," the Centers for Medicare & Medicaid Services says in a proposed rule recently posted to its Web site.

That means hospices cannot bill for higher-paying inpatient care due to "caregiver breakdown," even when the patient comes to stay in the inpatient facility. "'Caregiver breakdown' should not be billed as 'general inpatient care' regardless of where services are provided, unless the intensity-of-care requirement is met," CMS stresses in the hospice wage index proposed rule.

Scrutiny ahead: Hospices should bill at the respite care or routine home care rates instead, CMS directs. "We intend to monitor the usage of the general inpatient care," the rule warns.

The rule also sets hospice wage index levels for 2008 and clarifies some lingering wage index questions. And the regulation spells out that although CMS pulled back on its requirement that the attending physician and hospice medical director consult directly about patient eligibility, that doesn't mean the admission nurse can determine eligibility based on the patient's record.

The proposed rule is online at www.cms.hhs.gov/MLNProducts/downloads/cms-1539-p.pdf Hospices have until June 2 to comment on the proposal.

• The 60-day window for home medical equipment bidding should start soon. That's the latest word from CMS on the opening of the bidding process for Medicare's new competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

Best bet: Stay tuned to the Competitive Bidding Implementation Contractor Web site  (www.dmecompetitivebid.com) for updates and the announcement about the start of bidding, a CMS spokesperson tells Eli.

Initially, CMS reported that bidding under the DMEPOS competitive bidding program would open in late April. But on May 8, CMS posted an "important message" on its DMEPOS competitive bidding Web site saying that it has extended the target date for opening the bidding window to early May.

The extended target date will provide additional time for DMEPOS suppliers to review educational materials and prepare for bidding, and additional time for CMS to test its on-line bidding system, say officials.

• Even though CMS is putting mail-order diabetic supplies up for nationwide bid under durable medical equipment competitive bidding, it won't affect all providers and beneficiaries nationwide--at first.

At the April 23 National Association for Home Care & Hospice policy conference in Washington, DC, CMS' Carol Blackford noted that mail-order supplies would be going up for nationwide bid (see Eli's HCW, Vol. XVI, No. 15). That means home health agencies will have to do business with a bidding winner for mail-order supplies, Blackford stressed to attendees.

Limited number: But that restriction will apply only to beneficiaries contained in the first 10 competitive bidding areas (CBAs) in 2008, a CMS spokes-person tells Eli. For now, benes in other areas will be able to obtain their supplies from their usual supplier.

However, that's likely to change soon. Bidding is set to spread to 70 CBAs in 2009 and even further in subsequent years. That means you'll likely have to change the suppliers you do business with and explain those changes to patients.

Remember: Non-mail-order diabetic supplies are not included in the first phase of bidding, the CMS spokesperson points out. For a list of bidding items and other details, see Eli's HCW, Vol. XVI, No. 12.

• Get ready for NPI headaches to pick up steam. Regional home health intermediary Cahaba GBA will start checking for valid National Provider Identifier numbers on claims May 14. National Government Services (formerly Associated Hospital Service and United Government Services) will begin May 21 and Palmetto GBA will start May 29, the contractors say in messages to the providers they serve.

The intermediaries will check your NPI against your former Medicare legacy (OSCAR) number on the NPI crosswalk file. If your number doesn't check out with the crosswalk data provided by the National Plan and Provider Enumeration System, the claim will return to provider (RTP) or reject, the RHHIs explain.

Then you'll have to verify that you submitted the correct number and that your legacy identifier (OSCAR) number corresponds with the NPI on file with NPPES. Contact information is at https://nppes.cms.hhs.gov.

Watch out: If you continue to have NPI problems, you may have to submit a new Medicare enrollment form (855), the intermediaries warn.

• President Bush has nominated Department of Health and Human Services official Kerry Weems to be permanent CMS Administrator. Currently Leslie Norwalk is Acting Administrator, but she declined to be considered for the permanent position, according to press reports.

Weems has held a variety of top management positions within HHS, including deputy chief of staff, according to a CMS release. He would succeed Mark McClellan, who resigned from the position last fall.

Some observers were surprised to see the nomination go to a government agency veteran with largely financial and budget experience, rather than an outside political personality like former CMS Administrator Tom Scully and former HHS Secretary Tommy Thompson.

Next up: The Senate must now review the President's nomination.

• Gentiva Health Services Inc. reported increased profits but still missed analysts' earnings estimates for the latest quarter.

The Melville, NY-based home care giant nearly broke the $300 million mark in revenues with $299.5 million for the quarter ended April 2, compared to $243.2 million in the same period of 2006. The national chain's net income grew from $4.4 million to $6.8 million in that period.

Gentiva has nearly finished integrating its massive Healthfield Group Inc. acquisition from last year and will set its sights on streamlining operations, it says in a release.

• LHC Group Inc. saw earnings rise in the latest quarter. The Lafayette, LA-based regional chain reported net income of $6.3 million on revenues of $70.0 million for the quarter ended March 31, compared to a $4.1 million profit on $46.5 million in revenues for the same period in 2006.

LHC experienced 66 percent organic growth in its home care unit, with revenues increasing from $32.4 million to $55.1 million during the time period. The rest of the company's business is in long-term care and rehab facilities.

"Our growth in the home-based services group has been stellar," CEO Keith Myers crows in a release.

• After a battle with minority shareholders over a pending sale, Scarsdale, NY-based National Home Health Care Corp. will likely call off the sale to Angelo Gordon & Co. and will accept an offer of $12 a share by Premier Home Health Services, according to an NHHC press release.

Lawndale Capital Management, which owns 7 percent of NHHC's stock, earlier this year protested in a series of letters to the Securities & Exchange Commission that the Angelo Gordon sale was corrupt, among other problems (see Eli's HCW, Vol. XVI, No. 9).