Home Health & Hospice Week

Daily care with no realistic endpoint will sink your claims.

Get ready to defend your claims for patients receiving daily nursing care.

Regional home health intermediary Cahaba GBA has targeted claims with 55 nursing visits, a length of stay greater than 60 days and no therapies, the RHHI says in its May newsletter to providers.

The culprit: In a probe review of 72 such claims from August through February, Cahaba reviewers denied 69 percent. Home health agencies' main problem was not meeting the intermittent skilled nursing requirement.

"Intermittent skilled nursing care is a medically predicable, recurring need that is provided fewer than seven days each week or fewer than eight hours each day, for periods of 21 days or less," Cahaba explains in its May Newsline. "In exceptional circumstances, daily skilled nursing care may be covered as long as a finite, predictable, and reasonable endpoint is documented."

Do this: Repeatedly ordering daily care for 21 days doesn't meet the intermittent requirement, the RHHI maintains. The agency "must forward medical documentation justifying the need for such additional services and include an estimate of how much longer daily skilled services will be required," Cahaba instructs. "This should occur before the end of the initial three weeks of daily skilled nursing care."

Providers may have to accept that their patients aren't eligible for the Medicare home health benefit. "A beneficiary who is expected to need more or less full-time skilled nursing care over an extended period of time would not usually qualify for home health care," Cahaba says.

Exception: Daily visits are covered for diabetic patients who need daily insulin injections and don't have a caregiver to give them, Cahaba adds.

The review notice is at www.cahabagba.com/rhhi/news/newsletter/200805_rhhi.pdf.

• This year's Medicare legislative package continues to take shape in Congress. The Senate Finance Committee is considering legislation that would delay physicians' 10 percent Medicare payment rate cut for 18 months at a cost of up to $18 billion over five years, according to press reports.

Negotiations over where the Medicare funds will come from leaves home care providers vulnerable to payment cuts, industry observers warn.

The Centers for Medicare & Medicaid Services has informed Congress that it would require a June 16 passage date to make sure physician cuts don't take effect on July 1. However, Congress could always revise the cut retroactively.

• More states are waking up to the benefits of funding home care. The latest example is Connecticut, which has a bill pending in the state legislature that would help 5,000 elderly and disabled people move from nursing homes to their own homes and community-based housing, reports the Associated Press.

The state Senate has approved the measure and it now heads to the state House, AP says.

• The new Medicare accounting system that has caused major headaches for other HHAs now may be coming to you. Cahaba GBA will adopt the Healthcare Integrated General Ledger Account-ing System (HIGLAS) in late summer, it says in an email message to providers.

HIGLAS "will not replace the current claims processing system but will replace the current accounting functions ... now handled by the Contractor's processing system," Cahaba explains. "Once a claim is processed, HIGLAS will perform the payment calculation, formatting, and accounting."

Agencies served by Palmetto GBA and National Government Services saw problems such as slowed RAP payments, erroneous withholds due to tax ID number confusion and mail delivery mix-ups (see Eli's HCW, Vol. XVI, No. 29).

• Florida's state legislature on May 1 passed a bill fighting home care fraud and abuse. The legislation is awaiting the governor's signature, notes Warren Hebert with The Council of State Home Care Associations.

The bill's key provisions include penalties for a range of fraudulent behavior, including billing for services not rendered and offering kickbacks to referral sources and patients, notes Gene Tischer with the trade group Associated Home Health Industries of Florida.

Resource: Bill text and history are available at www.flsenate.gov --enter "7083" in the "Jump to bill" box.

• You can tap a new Web site to help your patients with their nutritional information needs. The National Institutes of Health has added "Eating Well as You Get Older" to the topics covered on its NIHSeniorHealth Web site.

The site, http://nihseniorhealth.gov/eatingwellasyougetolder/toc.html, offers information on wise food choices, food labels, food safety, meal planning and more.

• If you'd like a discount on the next Hospital and Healthcare Compensation Service salary survey, now's the time to act. HHAs that participate in the HHCS survey, conducted in conjunction with the National Association for Home Care & Hospice, can buy the resulting report at $135 instead of $295, HHCS says in a release.

For questionnaires and more information, go to www.hhcsinc.com. Data is due by Aug. 4.

• Home care providers have been busy making acquisitions, and they're not necessarily Medicare-focused. Infusion company Home Solutions has acquired Infusion Network of the Cape and Islands in Falmouth, MA, reports deal broker The Braff Group.

Home Solutions is owned by Chicago-based private equity group Flexpoint Partners, noted Pittsburgh-based Braff. "This transaction further demonstrates the extraordinary surge in private equity-sponsored activity in home infusion therapy," Braff maintains.

Braff announced another deal it brokered, ResCare Inc.'s acquisition of Select Health Care Services, an HHA in Baytown, TX serving 30 counties in the Houston area. "We are seeing more interest in firms with both Medicare and non-Medicare capabilities as buyers try to diversify and expand their service offerings," Steven Braff notes in a release.

Indianapolis-based Arcadia Resources Inc. has acquired home care provider Carolina Care with locations in with locations in Asheboro, Greensboro and Winston-Salem, NC, the company says in a release. "With the acquisition of Carolina Care, Arcadia will have the ability to service Medicaid CAP-MR clients throughout its North Carolina operations," Arcadia notes.

• For-profit hospice chain Odyssey Inc. is in the hot seat, thanks to its recent acquisition of VistaCare Inc.

The U.S. Department of Justice's civil division sent Odyssey a letter indicating that it is conducting an investigation of VistaCare billing and requesting documentation. "The DOJ is reviewing allegations that VistaCare may have billed the federal Medicare and TRICARE programs for hospice services that were not reasonably or medically necessary or performed as claimed," Odyssey says in its latest earnings release.

Odyssey's profits took a dip in the quarter ended March 31, which included one full month of its VistaCare acquisition's operations. The Dallas-based company reported net income of $1.5 million based on revenues of $123.3 million for the quarter, compared to a $3.7 million profit on revenues of $96.6 million for the same period last year.

Cap adjustments for 2006 that are just surfacing now cost the company $1.5 million while VistaCare "rampdown" costs totaled another $1.6 million, Odyssey says in the release. Additional development requests also slowed accounts receivable, the company noted.

• Justice has caught up to the former CEO of now-defunct Med Diversified Inc.

At the start of this decade, the company bought multiple home care providers including StaffBuilders (which became Tender Loving Health Care Services Inc.) and Chartwell Diversified Services Inc., only to go bankrupt after financier National Century Financial Enterprises collapsed (see Eli's HCW, Vol. XII, No. 35). Chartwell emerged as an independent company and bankrupt Med sold TLC to Crescent Capital Investments (now Arcapita), which in turn sold the chain to Amedisys Inc. this year (see Eli's HCW, Vol. XVII, No. 8).

A federal judge sentenced former Med CEO Frank Magliochetti to six months of home confinement, three years probation and more than a million dollars in fines and restitution for money laundering and tax fraud, according to a release from the DOJ's Federal Bureau of Investigation Boston Field Office.

Magliochetti laundered $330,000 from Med Diversified in 2002 and falsely claimed the money as a capital gain for taxes, prosecutors say. Magliochetti pled guilty to the charges in February.