Home Health & Hospice Week

Industry Notes:

Intermediary Targets Claims With Low Functional, High Service Domains

Can you prove your patients who are independently performing activities of daily living really need 10 therapy visits?

 If you have a patient with less than 15 points in the functional domain who still needs 10 or more therapy visits, your documentation had better be pristine.
 
Regional home health intermediary Cahaba GBA's medical review department initiated an edit of claims with a low functional domain - represented by an "E" in the HIPPS code - and a high service domain ("M"), due to "possible aberrant billing practices and vulnerabilities," the RHHI says in an article in its April bulletin to providers.
 
Basically, reviewers wondered why patients needed so much therapy if they could perform their activities of daily living (M0650, M0660, M0670, M0680, M0690 and M0700) with virtually no problems.
 
Cahaba denied 36 percent of the claims it reviewed from the edit. The biggest reason for denials: "documentation does not support homebound," Cahaba says. Reviewers shot down 23 percent of the denied claims for lack of homebound documentation.
 
"The homebound status is to be documented in the medical record frequently enough to reflect the beneficiary's current functional status, and at a minimum, at least once per certification/billing period," Cahaba says.
 
Second, with 20 percent, was a downcode for the patient having a hospital stay within 14 days of admission - the M0175 issue receiving so much attention from the feds lately (see Eli's HCW, Vol. XIII, No. 14).
 
Third was a downcode for the therapy visits not being medically necessary (18 percent) and fourth was no orders for the therapy (16 percent). Documenting verbal orders seemed to be a particular area of difficulty, Cahaba notes. 
 
For tips on bringing your therapy documentation up to snuff, see Cahaba's article at
www.iamedicare.com/Provider/newsroom/newslines/040104.pdf.

 

  • Your patients soon could qualify for a new program to manage their chronic disease, known as the "Voluntary Chronic Care Improvement Program."
     
    The Department of Health and Human Services in the April 23 Federal Register will call for "innovative proposals ... to run large-scale chronic care improvement projects" for 15,000 to 30,000 beneficiaries with complex diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease. Qual-ified organizations "must have demonstrated success in population-based chronic care improvement services," HHS says in a release.
     
    The Centers for Medicare & Medicaid Services will choose about 10 projects to run for three years, and might expand successful projects that improve quality of care, reduce Medicare costs and promote patient satisfaction.
     
    More information on the program and CMS' solicitation for proposals is online at
    www.cms.hhs.gov/medicarereform/ccip.

     

  • A requirement to conduct criminal background checks on your direct-care workers could be coming to your state sooner than you think.
     
    CMS has issued a call to states to submit proposals for the background check pilot, which was passed last December in the Medicare Modernization Act. CMS will send out formal solicitations in May, expects proposals by July, and plans to make its decision by October, the agency says in an April 8 letter to surveyors (S&C-04-25).
     
    The proposals, which should span from 2004 through 2007, should include penalties for home care and other long-term care providers who don't comply with the pilot program's requirements, CMS says.

     

  • The federal government is furnishing grant funding to help Americans seeking long-term care access home care benefits. HHS awarded $9 million in grants to 12 organizations to be "one stop" centers for long-term care information and referrals.
     
    The program, which is in its second round of funding, is "designed to promote greater balance in long-term care between home and community-based services and institutional care," said Assistant Secretary for Aging Josefina Carbonell in a release.
     
  • Baltimore-based Woodhaven Health Ser-vices and Columbia, MD-based Severn Healthcare are merging their infusion therapy businesses, the two companies have announced. The new company, known as "Severn Healthcare, a Woodhaven Health Services Company," will serve patients in Maryland, Washington D.C. and northern Virginia.
     
    Severn says it is the largest provider of infusion therapy in Maryland. Woodhaven is a pharmacy services company.

     

  • Two Gentiva Health Services Inc. insiders are dumping their stock, which reached a 52-week high April 8 at $16.16 per share.
     
    Former Olsten Corp. and Gentiva CEO Edward Blechschmidt sold nearly 275,000 shares for about $2.4 million a few days before former Olsten Corp. President Stuart Olsten filed a plan March 23 to sell a million of his shares, reports the Long Island Business News. As of April 12, Olsten had sold about 280,000 shares for $4.2 million, the paper reports.
     
    Olsten Corp. spun off Gentiva in 2000.
     
    Both men will continue serving on Gentiva's board of directors, the News says. Blechschmidt continues to own about 200,000 shares of the company.

     

  • Palliative Care Services of San Diego Hos-pice & Palliative Care Corp. has secured a contract with the State Department of Health Services' Office of AIDS to offer the AIDS Medi-Cal Waiver Care Management Program. 
     
    The program serves Medi-Cal beneficiaries of any age who are HIV symptomatic or who have an AIDS diagnosis and are at risk of placement in a nursing facility, the hospice says.

     

  • A former Virginia home health agency owner has been sentenced to 27 months in prison, more than $360,000 in restitution and participation in a substance abuse program, reports The (Norfolk) Virginian-Pilot.
     
    Robert Leahey pled guilty in January to filing through Xtra-Care Home Health Care Services in Norfolk 297 fraudulent claims for seven Medicaid recipients between January 1999 and April 2003.
     
    Leahey often paid family members to perform Medicaid services that he indicated were furnished by a qualified registered nurse and personal care aide, the paper says. In one case, the company continued to bill and receive payments for a patient seven months after the person died.

     

  • The president of the Johns Hopkins Home Care Group has resigned four months after the death of a two-year-old cancer patient due to incorrectly mixed total parenteral nutrition solution furnished by the provider, reports The Baltimore Sun. The resignation of Steven A. Johnson, who helmed the group for five years, is not related to the death and the subsequent state investigation finding numerous errors, Hopkins officials told the paper.

     

  • After the infamy of power wheelchair scams, law enforcement authorities are on the look-out for home nursing scams, which are gaining in popularity according to the Houston Chronicle.
     
    Some fraudsters are offering a free blood pressure check or other in-home service in return for a Medicare patient number, with which they bill Medicare for home care services never rendered, said Barbara McGinity of the Houston Better Business Bureau.
     
    "The system was designed for people who were honest," McGinity said. "The people who are dishonest can drive a bus through it," the paper reports.