Home Health & Hospice Week

Will your V58.3 claims measure up?

Get ready for increased scrutiny for claims with V58.3 as a primary diagnosis.

Regional home health intermediary Cahaba GBA will conduct a widespread review of prospective payment system claims with this code that denotes "Attention to surgical dressings and sutures," the RHHI says in an Oct. 6 posting to its Web site.

"Once selected, the claims will be reviewed for medical necessity," Cahaba says. That includes compliance with Centers for Medicare & Medicaid Services guidelines, contractor local coverage determinations, and correct billing and coding.

The RHHI will post the results of the probe on its Web site and use the information to guide provider education, it says. Topic code 5THBT will indicate the review, Cahaba says.

• High gas prices continue to plague home health agencies. Raising its mileage reimbursement rate from the old IRS limit of 40.5 cents to the new limit of 48.5 cents would cost Johnstown, NY-based Community Health Center more than $6,000 a month, reports The (Albany) Business Review.

Albany-based Visiting Nurses Home Care has had a few employees refuse shifts due to high fuel prices, director Kenneth Mooney told the newspaper. Community Health's Paula Reichel said employees have applied for jobs at institutions to avoid the travel inherent in a home care job.

Community Health has sent a letter to patients informing them they might not get to have the health care aide they want if the person isn't in their area that day. "Some [patients] weren't happy about that," Reichel told the Review.

• Norcross, GA-based Pediatric Services of America Inc. has agreed to pay New York's Medicaid program more than $239,000 to settle allegations that it sold used durable medical equipment to Medicaid beneficiaries while claiming the equipment was new, state attorney general Eliot Spitzer has announced.

PSAI's Elmsford, NY regional office sold used medical devices, such as pulse oximeters, suction pumps, feeding pumps and compressors to critically ill children, Spitzer alleges in a release. Between January 1998 and December 2003, PSAI purportedly claimed that it sold brand new DME to the Medicaid beneficiaries when other PSAI patients had previously used the equipment. PSAI didn't have proper documentation to verify that the DME the company furnished to patients was indeed new, Spitzer says.

Meanwhile, PSAI has agreed to sell its pharmacy business to Memphis, TN-based Accredo Health Inc. for $72 million in cash. PSAI would keep its Pensacola, FL-based unit dose pharmacy under the deal, which is subject to regulatory approval.

The cash will fund start-ups and strategic acquisitions and pay down debt, PSAI says in a release.

• Your carrier or intermediary can request documentation of a sample of your claims if it has already identified an overpayment. The contractor can do this to determine if the billing patterns that led to the overpayment have ceased, CMS explains in Transmittal 123 (Change Request 3703), dated Sept. 23.

• National chain TLC Health Care Services Inc. has acquired regional chain AccuMed Home Health for undisclosed terms, the Lake Success, NY-based company says in a release.

Austin, TX-based AccuMed has 35 agencies and more than 1,000 employees, the company says on its Web site. "The AccuMed acquisition adds TLC's market presence in three new states with 32 additional market locations, and virtually no overlap to our current geography," TLC CEO Wes Perry says in a release.

The lack of overlap means there is no plan to change local leadership or combine offices or staff, TLC says. And AccuMed agencies will continue on an interim basis to operate under their existing entity names.

AccuMed CEO and founder Mike McMaude will be TLC's new Chief Operating Officer. McMaude, a former Amedisys Inc. executive, started AccuMed in 1999, according to AccuMed's Web site.

The acquisition is funded by TLC parent Arcapita Inc. "Acquiring a high quality home nursing company such as AccuMed builds upon Arcapita's investment thesis that the home health industry is ripe for consolidation," Arcapita's Jack Draughon says in the release. "We continue to see a number of multi-site operation and hospital-based acquisition opportunities available, and maintain our intention to selectively acquire companies that best fit our acquisition profile."

• LHC Group Inc. has continued its buying spree with the acquisition of two home care companies for $3.5 million. The Lafayette, LA-based regional chain has purchased Able Home Health with four locations in Mississippi and two in Alabama. Able, with 85 employees and an average census of 200 patients, had combined net revenue of $3.9 million in 2004, LHC says in a release.

And the company has agreed to acquire an unnamed home health agency owned by a non-profit community hospital in Hot Springs, AR, LHC says. The company is considering several more acquisitions in its 15-state target area and plans to open 12 to 14 new agencies in its acquired service areas.

• Birmingham, AL-based Alacare Home Health & Hospice has secured a certificate of need (CON) to expand into Dale County, Alacare says in a release. Alacare's service area now includes 59 counties.

• Home care providers would be well advised to keep a close eye on their office staff. The director of administrative support services for the Visiting Nurse Association of Central Jersey in Red Bank, NJ admitted to scamming $900,000 from the VNA and government programs.

Robert P. Caruso used two real billing service companies to bill for bogus services that were never furnished by a phony company he created, reports the Asbury Park Press. Caruso pleaded guilty to one count of health care fraud from 2000 to 2004. The crime carries up to 10 years in prison and a fine of up to $250,000.

Assistant U.S. Attorney John Vazquez praised the VNA for investigating the fraud. "They are an example of corporate responsibility," Vazquez told the paper. "They put the evidence together for our office."