Home Health & Hospice Week

Be sure your documentation will back up claims with this red-flag diagnosis.

If your Parkinson's claim becomes caught up in Cahaba GBA's edit for the diagnosis, it will get denied four out of five times.

In an edit Cahaba used for home health agency claims with a diagnosis of Parkinson's disease, a length of stay greater than 60 days and therapy utilization of 10 or more visits, medical reviewers denied a whopping 80 percent of claims, the regional home health intermediary reports in its March newsletter to providers. The RHHI says it plans to continue the edit this quarter.

#1 reason: "The highest percentage of denials was related to medical necessity," Cahaba explains in the article about edit 5THBY. Typically the documentation didn't support a continued need for nursing or therapy visits.

Nursing visits for observation and assessment commonly go unsupported in the record. "Observation and assessment by a nurse is not reasonable and necessary where [clinical] indications are part of a longstanding pattern of the patient's condition, and there is no attempt to change the treatment to resolve them," Cahaba stresses.

Therapy visits need specific support such as objective measurements of progress. "Subjective statements such as 'walking further' or 'progressing well' do not alone support the coverage of further therapy visits," the RHHI cautions.

#2 reason: Providers often use Parkinson's as the primary diagnosis in error. "Parkinson's disease is a chronic disorder, and although it greatly affects a patient's health, it may not be the most specific skilled reason home health is currently seeing the patient," Cahaba advises. "The primary diagnosis is the chief reason for home health care and represents the most acute condition with the most intensive skilled services to be provided."

The article, including more tips to avoid denials, is at https://www.cahabagba.com/part_a/education_and_outreach/newsletter/200803_rhhi.pdf on p. 36.

• If you've run into claims rejections following the March 1 National Provider Identifier deadline, don't just resubmit claims and cross your fingers.

"Providers whose claims are rejected and returned to them should immediately contact their contractor before resubmitting that claim or submitting new claims for services provided to Medicare beneficiaries," the Centers for Medicare & Medicaid Services in-structs in a message to providers.

As of March 1, CMS required Medicare providers to include an NPI on claims. You can still include a Medicare legacy number too, but by May 23 all Medicare claims must be NPI-only in the main fields.

One the eve of the March 1 deadline, CMS reported an 88.5 percent rate of claims with NPIs submitted to durable medical equipment Medicare administrative contractors (DME MACs). Part A providers were submitting 99.9 percent of claims with NPIs.

• State governors at the recent National Governors Association meeting in Washington, DC discussed increasing home care utilization to curb long-term care spending in their states, according to press reports. Some policy-makers are afraid that the "woodwork effect" would actually increase LTC costs, because many more people would avail themselves of a home care benefit than a nursing home benefit. But because home care is so much cheaper than nursing home care, the so-called woodwork effect still would not increase LTC budgets, experts maintained.

• If you are a supplier subject to a medical review of Medicare claims anytime soon, expect the review request to come from a new front. In Change Request 5909, CMS notes that the durable medical equipment Medicare Administrative Contractors (DME MACs) are taking over the medical review function. Formerly, the DME Program Safeguard Contractors (PSCs) handled medical reviews.

New name: The same missive notes that the DME-PSCs are being renamed as Zone Program Integrity Contractors (ZPICs).

• Ever wonder why your patients are so susceptible to flu--and you're so busy giving flu shots--in winter? Researchers at the National Institutes of Health think they know why.

"Briefly, at winter temperatures, the virus's outer covering ... hardens to a rubbery gel that shields the virus as it passes from person to person," the NIH says in a release. In warmer weather, the protective gel melts to a liquid phase that isn't tough enough to protect the virus against the elements. Thus the virus loses its ability to spread from person to person, NIH researchers say in a study published in the March 2 issue of Nature Chemical Biology.

In cold weather, "like an M&M in your mouth, the protective covering melts when it enters the respiratory tract," study co-author Joshua Zimmerberg says in the release. "It's only in this liquid phase that the virus is capable of entering a cell to infect it."

More information about the study is online at www.nih.gov/news/health/mar2008/nichd-02.htm.

• The threshold for appealing claims to the administrative law judge or federal court went up Jan. 1. The amount in controversy threshold for ALJs is now $120 and for federal courts is $1,180, RHHI Palmetto GBA notes on its Web site. Those AIC amounts are up from $110 and $1,130, respectively, in 2007.

• For-profit chain Amedisys Inc. beat analysts' estimates to report stellar earnings for the quarter ending Dec. 31.

The company recorded $16.7 million in net income on $194.0 million in revenues for the quarter, up from an $11.4 million profit on $144.0 million in revenues for the same period in 2006.

The Baton Rouge-based company expects revenues to exceed $1 billion in 2008, after acquiring TLC Health Care Services Inc. (see Eli's HCW, Vol. XVII, No. 8).

Meanwhile, another Louisiana-based chain had more disappointing earnings for the quarter. LHC Group Inc. reported operating income of $6.4 million on revenues of $67.8 million for the quarter for its home care division. That compares to a $10.2 million operating income on $51.6 million in revenues for the same period in 2006.

The company's total earnings came in under analysts' forecasts. LHC terminated unprofitable commercial, managed care, and Medicare Advantage contracts, the company says in its earnings release.

• VITAS Healthcare Corp.'s parent Chemed Corp. reported increased earnings for its for-profit hospice chain. The Miami-based hospice division saw a net income of $16.8 million on $197.2 million in revenues for the quarter ended Dec. 31. That compares to a $13.5 million profit on $186.2 million in revenues for the same period in 2006.

Chemed touted VITAS' lack of trouble with the per-patient hospice cap in 2007. The company also saw a shift from high acuity care to routine home care, but the change didn't affect profitability, according to the release.

• Odyssey HealthCare Inc.'s acquisition of VistaCare Inc. is moving ahead, despite opposition from one major VistaCare stockholder. Odyssey now owns 84 percent of VistaCare's stock, which it bought in its initial offer period for $8.60 per share, the Dallas-based company says in a release.

Odyssey hopes to buy more shares during its subsequent offering period for the same price. If it reaches 90 percent ownership, "under Delaware law the merger will be completed without a meeting of VistaCare's stockholders," the for-profit hospice chain notes in the release. If it doesn't reach 90 percent, dissenting stockholders will have appraisal rights for their shares.

New York-based investment firm Accipiter Capital Management, which owns nearly 10 percent of VistaCare stock, maintains its opposition to the merger. "We continue to believe that the VSTA Board of Directors is selling the Company for a discount bid," Accipiter says in a release.

Accipiter urges other stockholders not to tender their shares and to hold out for appraisal rights. The firm also urges Odyssey to offer a higher price for the shares.

• Your patients can draw on new resources from the NIH for help with urinary incontinence. In addition to existing tools, the NIH's National Institute of Diabetes and Digestive and Kidney Diseases has a new booklet for patients, "What I Need to Know about Bladder Control for Women." The booklet includes a worksheet, bladder diary, tip sheet, log for performing pelvic muscle exercises and a list of bladder control medicines doctors might prescribe, along with side effects.

The NIDDK also has a new booklet on urinary retention for women, it adds in a release. The tools are online at www.kidney.niddk.nih.gov/kudiseases/pubs/bladdercontrol/index.htm.

• Publicly traded home care companies are getting some broader publicity for the home care in-dustry. A report in a recent issue of Investor's Business Daily highlights two innovators in home health.

The article, in the Feb. 19 issue, features news of HHA and hospice regional chain LHC Group and its service area concentration. "Our focus on rural markets is a benefit because there's less managed-care penetration in those markets, and managed-care companies are the poorest payers for home health," said LHC Chief Executive Keith Myers.

The article also praises about-to-become national chain Amedisys' use of technology. "At Amedisys, nurses and therapists wield laptops to feed clinical information back to the company's central data center," says the article.