Home Health & Hospice Week

Cuts could develop quickly as congressional session winds down.

Previously proposed cuts to home care providers' Medicare reimbursement have been laid to rest, but a new threat could be emerging.

New legislation coming out of the Senate Finance Committee would avert the 10 percent payment reduction to physicians slated for Jan. 1. But instead of proposing home care cuts to pay for the change as the former State Children's Health Insurance Program bill did, reductions to Medicare Advantage plan rates would solely pay for the bill.

MA plans are a favorite target amongst lawmakers after the controversy over unethical marketing by so-called private fee-for-service plans (see Eli's HCW, Vol. XVI, No. 20). But "this is not a slash and burn exercise here on Medicare Advantage," Democratic committee aide Shawn Bishop said in a statement.

The legislation is far from finalized, experts warn. Although it doesn't contain home care cuts at the moment, legislators could easily add them in, especially if the powerful managed care lobby proves persuasive and Congress must look for another funding source for the physician payment fix.

Congress is currently working under continuing resolutions that allow the government to operate past the Sept. 30 fiscal year end, although no appropriations bills have been passed. More CRs are likely forthcoming, observers note.

Ray of light: President Bush has signed a bill that may give home health agencies hope. A "health extenders" bill (H.R. 3668) signed into law Sept. 29 pares the amount by which the Centers for Medicare & Medicaid Services can reduce hospital payment rates for alleged upcoding under the inpatient prospective payment system. The bill reduces the hospital upcoding adjustment from 1.2 percent to 0.6 percent in 2008 and  from 1.8 percent to 0.9 percent in 2009.

HHAs hope that Congress will include similar provisions to curb the 10.96 percent in cuts over four years that CMS plans under home health PPS.

• Is the worst over? That may be on the minds of federal officials as well as suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) now that the bidding window in the first round of Medicare competitive bidding has closed.

All bids in the first round were due Sept. 25. The final numbers aren't in, but CMS estimates that it received more than 15,900 bids. Of those, about 60 percent will win contracts.

• You can count on one more variable to make the new year even crazier than usual. CMS has set a deadline for Medicare providers to begin using National Provider Identifiers. "Effective January 1, 2008, your Medicare fee-for-service claims received must include an NPI in the primary fields on the claim (i.e., the billing and pay-to fields)," CMS says in a message to providers

You can submit NPI/legacy pairs in those fields or submit only your NPI, CMS explains. "Claims with only a Legacy provider identifier for the primary fields will be returned as unprocessable."

Providers can continue to include legacy numbers only for the secondary fields, such as referring physicians, CMS adds.

Tip: If your claims with legacy pairs are processing fine, now's a good time to try submitting a test batch of NPI-only claims, CMS suggests. "This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims."

• The HHS Office of Inspector General has two new HHA investigations planned for the coming year, according to its fiscal year 2008 Work Plan. The OIG will scrutinize "accuracy of coding and claims for Medicare home health resource groups," according to the plan. "We will assess the accuracy of HHRG assignment and identify potential patterns of upcoding by HHAs," the OIG says.

The agency will also examine accuracy of Home Health Compare data. And it will continue a project looking into whether HHAs fall into cyclical non compliance with Medicare regulations under the 36-month survey schedule.

Hospices will continue to be in the hot seat for nursing home relationships. "Medicare hospice spending doubled from $3.5 billion to $7 billion from 2001 to 2004, with the growth associated mostly with nursing home residents," the OIG notes.

Topping the hit list: Durable medical equipment suppliers will see the most scrutiny in the coming year. The OIG has a multi-page list of DME-related projects in the works or planned to launch in 2008. Topics range from South Florida abuse and diabetic supplies to power wheelchairs and nursing homes.

The Work Plan is online at http://oig.hhs.gov/08/Work_Plan_FY_2008.pdf.

• You may notice the number of your patients enrolled in private fee for service (PFFS) managed care plans on the rise again.

CMS told the seven MA plans that halted marketing of PFFS products this summer that they could resume the marketing. "CMS conducted a comprehensive review of these seven sponsors and found vast improvements to their internal controls and oversight processes consistent with regulations and guidance," acting CMS Administrator Kerry Weems says in a statement.

Lawmakers aren't so sure. "Talk is cheap and I look forward to action when PFFS plans are again caught misleading Medicare beneficiaries," House Ways & Means Health Subcommittee Chair Pete Stark (D-CA) says in a statement.

"The recent unscrupulous tactics by some MA plans have led me to be skeptical about how well this market works for seniors, and whether CMS is sufficiently protecting seniors in the market," Senate Finance Chair Max Baucus (D-MT) says in a statement. Baucus has sent a letter to Weems asking for more information on how CMS will oversee PFFS marketing.

• Clients will have to pay nearly $3 more a month for their Medicare Part B premiums for DME, outpatient therapy and other Part B services and items in 2008. The 3.1 percent increase of $2.90 over current premiums will total a $96.40 monthly payment, according to press reports.

The annual deductible for Medicare Part B will increase from $131 to $135 in 2008, while the annual deductible for Medicare Part A will increase by $32 to $1,024 in 2008, CMS says.

• More seniors are staying in their homes instead of going into nursing homes. About 7.4 percent of U.S. residents age 75 and older lived in nursing homes in 2006, compared with 8.1 percent in 2000 and 10.2 percent in 1990, according to recent U.S. Census Bureau data, USA Today reports.

• Medicare beneficiaries are less happy with 1-800-MEDICARE. Seventy-one percent of 2007 callers were satisfied with overall customer service compared to 84 percent in 2004. Wait times were a major concern, according to a report from the HHS Office of Inspector General (OEI-07-06-00530).

• LHC Group Inc. is partnering with a Nashville, AR hospital to operate a home health agency. The Lafayette, LA-based chain will purchase a controlling interest in Howard Memorial Hospital Home Health Services from Howard Memorial Hospital and will oversee the agency's day-to-day operations, LHC says in a release.

The partnership, which will operate under the name of Southwest Arkansas HomeCare, will have a service area with a 50-mile radius around Nashville. The agency has annual revenues of about $700,000, the regional chain says.