Home Health & Hospice Week

Incorrect caps could cost you.

Warning: If you're a hospice whose Medicare reimbursement bumps up against the per beneficiary cap amount, you may have to give money back to Medicare for previous years.

The Centers for Medicare & Medicaid Services has finally settled on a cap amount for 2003 and 2004. Nearly two years ago, the agency announced it had incorrectly computed hospice caps in previous years (see Eli's HCW, Vol. XIV, No. 31).

The caps are $18,143.26 for the cap period ending Oct. 31, 2003 and $18,963.47 for the cap period ending Oct. 31, 2004, CMS says in April 20 Transmittal No. 1226 (CR 5596). That's down from the originally stated $18,661.29 and $19,635.67, respectively.

CMS will come knocking if you received too much reimbursement for those years as a result of the incorrect caps. Regional home health intermediaries and other contractors must recompute the 2004 aggregate cap for each hospice and issue resulting demand letters by July 31, the transmittal instructs.

For 2003, RHHIs can issue demand letters only if the hospice received a cap determination in time for the three-year reopening period to be valid now, CMS advises.

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R1226CP.pdf.

• RHHI Cahaba GBA will eyeball more claims that have a primary diagnosis of 344.61 (Cauda equina syndrome with neurogenic bladder).

Cahaba's initiating a widespread review be-cause a probe that covered the last half of 2007 denied 41 percent of such claims.

The probe, which reviewed claims from 54 providers, denied about half of the claims due to incorrect diagnosis. HHAs receive an extra 20 case mix points for using 344.61 rather than 596.54 (Neurogenic bladder, NOS).

Cahaba denied another 20 percent of cauda equina claims as not medically necessary, the intermediary says in a post to its Web site at www.cahabagba.com/part_a/whats_new/20070424_hhpps.htm.

• It's official: Home health agencies in durable medical equipment competitive bidding areas will no longer be able to bill their own regional home health intermediary for DME once bidding begins.

So says CMS in April 20 Transmittal No. 1224 (CR 5551). "HHAs that furnish DME and are located in an area where DME items are subject to a competitive bidding program, must either be awarded a contract to furnish the items in this area or use a contract supplier in the community to furnish these items," CMS says in the transmittal.

However, HHAs that are not in a bidding area still can bill the RHHI for DME, CMS explains. Bidding starts in 10 metro areas next year and will spread to 70 areas in 2009.

If you submit a claim for a bid item, the claim will come right back to you. "Claims submitted to the RHHI for HCPCS codes subject to a competitive bidding program will be returned to the provider to remove the affected DME line items," the agency instructs providers. "The providers will be advised to submit those charges to the DME MACs, who will have jurisdiction over all claims for competitively bid items."

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R1224CP.pdf.

• It's too late to comment on the proposed revisions to the Advanced Beneficiary Notice used by home medical equipment suppliers and hospices, but stay tuned for updates.

Speaking at the home health Open Door Forum on April 25, CMS' Elizabeth Carmody said that the agency hoped to issue a final rule by the end of May.

CMS accepted comments on the proposed ABN rule through April 24.

 • Home care providers must work full steam ahead on National Provider Identifier compliance, a CMS official said in the April 25 home health Open Door Forum.

If you won't be fully adopting NPI standards by May 23, 2007--including obtaining and entering referring physicians' NPIs on home care claims--you'll need a contingency plan that shows how you're working toward full adoption, the official stressed. (For tips on crafting NPI contingency plans, see Eli's HCW, Vol. XVI, No. 14).

Hospices should remember to include the physicians they work with in their NPI efforts, RHHI Cahaba GBA reminds in its May newsletter to providers. "An NPI will be needed for attending physicians, the hospice medical directors, and nurse practitioners," Cahaba says.

• HHAs will get more help in filling out OASIS. CMS recently mailed out DVDs of OASIS training clips to every Medicare-certified HHA in the country, CMS' Pat Sevast said at the April 23 National Association for Home Care & Hospice policy conference in Washington, DC. Agencies can also go to www.oasistraining.org to request the DVDs or access enhanced Web training, Sevast suggested.

CMS is also bringing the Q&As up to date, Sevast told attendees.

• Pediatric Services of America Inc., which does business as PSA Healthcare, will go private. Washington, DC-based investment firm Portfolio Logic will buy all of PSA's outstanding shares and take the company out of public trading. PSA offers pediatric home health care services through a network of 59 branch offices in 18 states, it says in a release.

• Amedisys Inc. is making no secret of its national ambitions. The Baton Rouge, LA-based chain that stretches across the Southeast is entering the Illinois and Michigan markets by acquiring 11-agency Dyna Care Health Ventures Inc. Chicago-based Dyna Care has locations in Illinois, Michigan, Indiana, Arizona and Texas, Amedisys notes in a release.

And in its latest earnings release, Amedisys touts itself as the "nation's leading market provider in the home health services industry," according to CEO William Borne. "We are well positioned to continue to take advantage of future potential acquisitions ... and to initiate operations in markets that we feel have the most potential to add additional returns," Borne says.

Amedisys reported net income of $13.3 million on revenues of $153.6 million for the quarter ended March 31, up from a $7.3 million profit on $127.2 million in revenues for the same period in 2006.