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Home Health & Hospice Week

Industry Notes:

HOSPITALS GOOFING UP HOME CARE TRANSFERS

Published on Sun Jun 01, 2003

Hospitals could take steps to alter their home care transfer policies if they're forced to tighten up their related billing.

Hospitals with high error rates for post-acute transfers could be in for aggressive enforcement actions from federal regulators. Hospitals collected more than $60 million in overpayments in 2000 based on improperly classifying transfer patients as discharges, the HHS Office of Inspector General estimates in its latest review of post-acute transfer compliance.

Under the post-acute transfer policy, if a hospital discharges a beneficiary in one of 10 specified diagnosis related groups to a post-acute provider - including home care - the hospital should treat the discharge as a transfer for payment purposes. That means Medicare pays the hospital a per diem rate for the patient's care, rather than the full DRG amount.

Compliance with the rule is something of a train wreck. Out of 200 claims the OIG reviewed, 188 resulted in improper payments, the agency says in "Compliance with Medicare's Postacute Care Transfer Policy for Fiscal Year 2000" (A-04-02-07005).

One problem could be that a hospital has no way of knowing whether a patient receives home care after discharge.

Nevertheless, both the OIG and the Centers for Medicare & Medicaid Services are frustrated with the results - and the agencies may be about to pounce. "We are interested in exploring potential cooperative arrangements with OIG to identify, investigate, and sanction abusive hospitals," CMS chief Tom Scully warns.

Tough enforcement could mean hospitals become stingier with home care referrals.

The DRGs affected by the policy are 014, 113, 209, 210, 211, 236, 263, 264, 429 and 483. The report is at http://oig.hhs.gov/oas/reports/re-gion4/40207005.htm.

  • The OIG is investigating Gentiva Health Services Inc. and served the company with a document subpoena April 17, the Melville, NY-based home health giant revealed in its quarterly filing with the Securities and Exchange Commission May 14. The subpoena seeks information regarding implementation of prior settlements with the government, implementation of corporate integrity agreements and Gentiva's "treatment on cost reports of employees engaged in sales and marketing efforts," the company says.

    Gentiva is cooperating with the government and is talking with it regarding the "timing and scope of production," it says. The government hasn't filed a complaint against the company to Gentiva's knowledge, the company notes in the filing.

  • Payors need to loosen up their requirements for hospice and palliative care to be more flexible, says a new study by the National Institutes of Health. Limiting hospice and palliative care to patients with a six-month prognosis means many patients who need the services must go without, says the study that appeared in the May 14 issue of the Journal of the American Medical Association.

    Only 23 percent of Americans die of cancer, the most common illness with a distinct terminal phase. People who slowly get worse but go home between hospital stays and who become frail and elderly need palliative care earlier than the six-month limit, says the study.

  • Medicare will pay physicians nearly twice as much to interpret home oxygen tests starting in July, CMS says in May 9 program memorandum AB-03-070. Codes 94014 and 94015, created in 1999 to report spirometric measurements taken by a patient at home, will reimburse an average of $55.14 and $29.77 respectively. That's up from past reimbursement of $36.02 and $10.66 respectively.

  • The Joint Commission on Accreditation of Healthcare Organizations is establishing a group to help address the nursing crisis. JCAHO has created a 30-member Nursing Advisory Council to help implement the recommendations contained in its recent report, "Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis."

    The nursing shortage is forcing HHAs to refuse admissions, notes the report at www.jcaho.org/about+us/public+policy+initiatives/health+care+at+the+crossroads.pdf.

  • A House bill, the Nurse Loan Forgiveness Act (H.R. 501), would use federal funds to repay nursing student loans if passed. The repayments would gradually increase from $2,000 to $5,000 the longer the person was employed as a nurse, according to the bill introduced by Reps. Tom Tancredo (R-CO) and Loretta Sanchez (D-CA). The bill proposes a cap of $17,000 in loan forgiveness, notes the National Association for Home Care & Hospice.

  • CHAD Therapeutics Inc. has reported a net loss of $841,000 on revenues of $4.7 million for the quarter ended March 31, compared to a $996,000 profit on revenues of $4.2 million for the same period in 2002.

    The quarter's results include a previously announced non-cash charge of $934,000 for the write-off of an intangible license fee asset, says the Chatsworth, CA-based oxygen company. They also include "$165,000 in unanticipated expenses incurred in connection with a proxy contest waged by a group of dissident shareholders who attempted unsuccessfully to elect nominees to CHAD's Board," the company notes in a release.

  • Med Diversified Inc. has sold off its distance medicine unit, Trestle Corp., to Trestle Acquisition Corp., a wholly owned subsidiary of Los Angeles-based Sunland Entertainment Co. Inc. "Proceeds from the sale, in the amount of $1.25 million, plus the assumption of certain liabilities totaling approximately $368,000, will remain in escrow pending completion of the Company's reorganization," says bankrupt Med. A bankruptcy judge approved the sale May 12.

  • Regional home health intermediary United Government Services has played fast and loose with compensation rules surrounding Y2K preparation, the OIG says in a recent audit report. From Oct. 1 1997 to Sept. 30 1999, "UGS improperly charged Y2K for $45,278 of compensation for supervisors working less than 100 percent on Y2K; could not support other compensation costs of $3,724; and claimed unallowable employee meal costs of $921," the OIG says in a summary of its report (A-05-02-00054).

    The OIG wants UGS to charge supervisor compensation of $45,278 to non-Y2K Medicare activities and make a financial adjustment for the remaining $4,645.

  • Congestive heart failure patients using HomMed telemonitors for an average of 56 days experienced 3.2 fewer hospitalizations and 3.3 fewer emergency room admissions per 100 days on home care than before using the telemonitors, reports a study by Santa Barbara, CA-based infor-matics company Strategic Healthcare Programs.

    HomMed-monitored CHF patients in another study had 37.7 percent fewer hospitalizations and 10.6 percent fewer ER admissions than non-monitored patients, says SHP. Among NYHA Class III and IV CHF patients, those using HomMed telemonitors had 65.9 percent fewer hospitalizations and 61.7 percent fewer ER admissions than non-monitored patients, SHP notes.

  • Critical Home Care Inc. has inked a deal with Comprehensive Health Care Services, New York to provide equipment to its obstructive sleep apnea patients, the Westbury, NY-based DME and respiratory therapy company says. Comprehensive Health Care operates New York sleep disorder centers in Great Neck, Brooklyn and Lynbrook, says Critical Home Care.

     

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