Home Health & Hospice Week

The double standard for Medicare contractors versus Medicare providers is evident once again in appeals priorities issued by the Centers for Medicare & Medicaid Services. Intermediaries and carriers should use the priorities set out by CMS in Aug. 22 program memorandum AB-03-133 when "the budget amount is insufficient to adequately perform the required functions" for appeals, CMS says. "If providers are even a day late, they are out of the ballpark," protests Burtonsville, MD-based attorney Elizabeth Hogue. "But there is so much leeway for contractors that [appeals] time-lines almost seem meaningless." "It almost looks like contractors could say they didn't meet targets because they were too busy," Hogue says. Topping contractors' appeals priority lists are implementing decisions from a variety of bodies ranging from administrative law judges and the Departmental Appeals Board down to medical review. At the bottom of the priority list are forwarding hearing files that don't contain the necessary documentation in the required timeframes, CMS says in the memo. "I really wish that there were some 'teeth' here," Hogue continues. "For example, why not penalize contractors financially when they don't meet deadlines?" Three more specific codes for speech-generating devices will replace K0542 in the New Year, CMS says in Aug. 22 program memo AB-03-128. K0542 (speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes recording time) will fall by the wayside in favor of three codes that specify devices with recording times of 8 to 20 minutes (K0615), 21 to 40 minutes (K0616) and 41 minutes or longer (K0617). Carriers and intermediaries will implement the coding changes Jan. 1, 2004, but they are effective July 1 of this year. Add three new SARS-related diagnosis codes to the list that takes effect Oct. 1. Codes for SARS-associated coronavirus (079.82), pneumonia due to SARS-associated coronavirus (480.3) and exposure to SARS-associated coronavirus (V01.82) were left off CMS' original list to its contractors because the National Center for Health Statistics only recently issued the new codes, CMS says in Aug. 22 memo AB-03-129. Legislators return from August recess to Washington this week and will continue negotiating an agreement on the bill including Medicare changes and a prescription drug benefit. Home care lobbyists will follow shortly after, with the National Association for Home Care & Hospice and the American Association for Homecare staging a "March on Washington" Sept. 10. Observers still doubt whether an agreement can be reached on the controversial drug benefit. Instead, a separate bill on other Medicare issues - including home health copayments, durable medical equipment competitive bidding and other home care provisions - may emerge before this year's session wraps up. The home health prospective payment system needs a lot of fine-tuning, and CMS should [...]