Home Health & Hospice Week

Home health agencies in Florida and Texas will see even more scrutiny in the new year.

Regional home health intermediary Palmetto GBA has identified three high utilization countiesin Texas (Dallas, Houston, McAllen) and one in Florida (Miami) that will undergo special education and monitoring, the RHHI says in its January newsletter for providers.

"Based on analysis by county, one county accounted for one third of the charges for Florida and three counties accounted for one third of the charges in Texas," Palmetto explains.

Watch for: Palmetto will be sending "Comparative Billing Reports" to "high utilization" providers in these four counties, the contractor says. The reports will compare agencies' utilization to state and national averages.

Palmetto urges such high utilization home health agencies to double-check their Medicare compliance, determine their risk level for receiving home care overpayments, and remedy any overpayments found.

Palmetto will hold educational workshops in these counties in April, May, and June. "Providers in these areas ... are strongly encouraged to attend one of these educational opportunities," the RHHI urges.

• If you'd like to know the details of how the 10 percent outlier cap will work, you now can look at the Centers for Medicare & Medicaid Services' marching orders to its contractors.

On a claim-by-claim basis, the Medicare claims system will tally an agency's total amount of regular prospective payment system payments and the total amount of outlier payments to determine the 10 percent limit for each agency, CMS explains in Dec. 23 Transmittal No. 1883 (CR 6759).

Since claims billed later may change the cap amount for agencies, CMS will run a quarterly reconciliation process to pay outliers that were denied at the time, the agency explains in a related MLN Matters article.

The system won't pay part of an outlier claim, the transmittal clarifies. If the amount of the outlier payment is more than the available outlier pool the agency currently carries, the system will pay just the regular PPS amount, not the outlier portion.

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R1883CP.pdf and the MLN Matters article is at www.cms.hhs.gov/MLN MattersArticles/downloads/MM6759.pdf.

• Hospices have an extra three months to get up to speed on a new claims reporting requirement for physicians.

In a November transmittal, CMS instructed hospices to put the certifying physician's National Provider Identifier (NPI) in the "Other physician" field. The attending doc would go in the usual attending physician field (see Eli's HCW, Vol. XVIII, No. 42, p. 328).

Now CMS is making that reporting changeoptional until April 1, the agency says in Dec. 23 Transmittal No. 1885 (CR 6540). Starting with claims with dates of service April 1 or later, the requirement will be mandatory.

Tip: "Both the attending physician and other physician fields should be completed even if the hospice physician certifying the terminal illness is the same as the attending physician," CMS says in a related MLN Matters article.

• Don't forget to check your state's OASIS State Welcome Page and the QIES Technical Support Office at www.qtso.com to find out exactly when you'll have to change your OASIS login information.

Home health agency staff will have to beginusing individual logins, rather than an agency login shared by HHA staff, CMS notes in an e-mail message to providers. HHAs will begin changing logins on a state-by-state basis in February and finish by August, CMS expects.

• If you're a durable medical equipment supplier who hasn't obtained accreditation, you'll soon have to pay the piper. The Medicare DME claims system will implement an edit that will autodeny DME claims if you haven't submitted proof of  accreditation, CMS says in Dec. 23 Transmittal 613 (CR 6566).

But the edit won't fully hit on the July implementation date. The system "shall begin this process by phasing in a limited number of product categories and HCPCS codes," CMS says in the transmittal.

The product categories first affected include those for oxygen, wheelchairs, diabetic mail-order supplies, enteral nutrition, CPAPs, respiratory assist devices, hospital beds, and walkers. In Miami only, the edit will apply to certain support surface items.

More information is in the transmittal online at www.cms.hhs.gov/transmittals/downloads/R614OTN.pdf.

Meanwhile, suppliers who are starting or acquiring new locations or who voluntarily relinquished billing privileges pending accreditation are facing long waits for new billing numbers from the National Supplier Clearinghouse, due to the crush of suppliers who turned in paperwork right before the October accreditation deadline, reports the

National Association of Independent Medical Equipment Suppliers.

"All suppliers were aware of the deadline," NAIMES blasts. "A delay in accreditation should not be rewarded with priority handling."

• The next Home Health Quality Improvement campaign will kick off this month witha "summit" at CMS headquarters Jan. 13.

This time around, the campaign aims to improve the acute care hospitalization rate by reducing avoidable hospitalizations, says HHQI contractor WVMI & Quality Insights. The campaign will also work on improving the management of oral medications.

More information about the grassroots initiative is at www.homehealthquality.org.

• HHAs and hospices that use the Joint Commission for system accreditation will see a little less work. The Oakbrook Terrace, Ill.-based accrediting body has reduced the sample size of records reviewed for resurveys, the Joint Commission says on its Web site.

Sample size was formerly 25 percent, but now it will go down to as low as 10 percent, depending on the size of the organization, the Joint Commission says.

Remember: HHAs and hospices that use Joint Commission accreditation for deeming aren't eligible for the system-wide accreditation option.

• If you're trying to improve your hospice relationship with nursing homes, you have some new ammunition.Harvard researchers have concluded that using a hospice for skilled nursing facility patients benefits all SNF patients, not just those in hospice.

That's according to a study report published in a recent issue of the Journal of Pain and Symptom Management.

Among the SNF-hospice combo bright spots, the researchers found that SNF hospice patients have fewer hospitalizations and improved pain management, compared to end-of-life SNFpatients who don't choose hospice.

Also, there was a positive effect on nonhospice SNF patients when there was a hospice involved, a trend they link to improved clinical practices across the board at the SNFs.

• Don't count on reopening your cost report to claim additional reimbursement if you're a hospital-based HHA. Your originally filed cost report should contain all of your costs, chides RHHI Cahaba GBA in a message to providers.

Providers don't have a right to a cost report reopening and Cahaba won't grant it for any little thing, it says. "Only in the exceptional case, where a provider can demonstrate by a preponderance of evidence that true, correct and complete claims for Medicare payments could not otherwise be determined and presented in the originally submitted cost report, will we grant a provider's request for cost report reopening," it says.

• National HHA chain Amedisys Inc. has been named by Fortune magazine as one of thenation's 10 best stocks for 2010, the Baton Rouge, La. company says in a release. Amedisys' earnings grew 32 percent a year over the past five years, Fortune notes.

Becoming "operationally efficient" has given Amedisys a strategic advantage, CEO Bill Borne says in the release.