Home Health & Hospice Week

Your 2008 payment rates are on the budget chopping block.

The clock is ticking on this year's congressional session, but there's plenty of time left for lawmakers to slash your Medicare payment rates for next year.

The Senate Finance Committee plans to consider Medicare legislation Dec. 5, upon returning from Thanksgiving recess.

Lawmakers aim to eliminate physicians' 10.1 percent cut in Medicare reimbursement, which means they'll be looking to make cuts to other providers' payments--and home care is a likely target.

"A physician 'fix' may cost from $18 billion to $24 billion dollars," warns the National Association for Home Care & Hospice. "This puts all other Medi-care providers at risk of payment cuts."

Timeline: Legislators would like to wrap up budget work before Christmas, NAHC notes.

Providers such as nursing homes and managed care plans are firing up their lobbying machines to fend off cuts in their arenas, and home care is no exception. Former Sen. Bob Dole (R-KS) has sent a letter urging key Senate Finance members to avoid home care cuts, NAHC reports.

"I hope you will continue to preserve the full market basket update for home health providers and offer some help to address the extensive regulatory cuts," Dole said in the letter. Dole is special outside counsel for NAHC.

At a Nov. 15 House Small Business Commit-tee hearing, the trade group also denounced the payment cuts for case mix creep that CMS will implement Jan. 1. The manner in which the Centers for Medicare & Medicaid Services is implementing the cuts has gone against the Regulatory Flexibility Act, NAHC charged.

Take action: The association urges home health agencies to contact their representatives to enlist their support for home care.

• Round two of competitive bidding is coming--but suppliers will have to wait for bidding details.  "DMEPOS competitive bid instructions ... will be released closer to the 2008 bid window," CMS noted Nov. 20. More information will be forthcoming on the CMS Web site soon, an agency official promised in the Nov. 28 home health Open Door Forum.

• CMS will use a Common Working File edit to fix its LUPA payment problem under the prospective payment system revisions, according to NAHC. Under the low utilization payment adjustment (LUPA) error, the claims system will sometimes give the $87.93 LUPA add-on to second episodes when it should only apply to first or sole episodes (see Eli's HCW, Vol. XVI, No. 40).

As a CMS official has told Eli, the edit won't begin until July. "In the meantime, there's no way to avoid erroneously paying the add-on to [the] second LUPA episode," the trade group warns. "Therefore, home health agencies should plan to hold any overpayments in reserve until advised by CMS of repayment procedures."

• The feds are cautioning home medical equipment suppliers not to sign on for a new service.

The Centers for Medicare & Medicaid Services said in November that it would soon offer access to a new system, the Individual Authorized Access to CMS Computer Services--Provider Community (IACS-PC). Providers must sign up for the service to eventually use new applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet.

"CMS does not expect any new online services will be available to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in 2008," the agency announced Nov. 20. "Therefore, DMEPOS suppliers should not register for IACS-PC, at this time."

HHAs eager to learn more about IACS-PC should check out the new MLN Matters article, which addresses key questions and answers about the registration process. To view the article, go to www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf.

• As promised, CMS has issued a corrected version of the grouper software for the PPS revisions that take effect Jan. 1. The reissuance includes a revised grouper logic/pseudocode and associated tables, the agency explains.

More details are at www.cms.hhs.gov/HomeHealthPPS/05_CaseMixGrouperSoftware.asp.

• Be sure to double-check your NPI data for Social Security Numbers (SSNs), CMS urges in a message to providers. SSNs should never be in your NPPES records because they are publicly available.

CMS currently suppresses any nine-digit numbers for its NPI registry, but the information is still publicly available and could be replacing a legitimate number, such as an Employer ID Number (EIN), needed for accurate payment.

Do this: Go to https://nppes.cms.hhs.gov/ and make sure there are no SSNs in your files, CMS instructs.

• Docs will see less Medicare reimbursement for home care services if Congress fails to avert the 10.1 percent cut scheduled for Jan. 1.

Right now, the average 2008 rate for the following physician home care services is: $52.12 for home health certification (G0180); $39.85 for home health recertification (G0179); $93.00 for home health care plan oversight (G0181); $96.41 for hospice CPO (G0182); and $57.23 for hospice evaluation (G0337), according to the National Association for Home Care & Hospice.

• Don't worry about survey problems related to the five-day window for OASIS assessments at the end of the month, CMS' Pat Sevast told the recent OASIS Certificate and Competency Board annual conference in Baltimore. CMS is granting M0090 exceptions for certain OASIS assessments in that timeframe and requiring agencies to use an "artificial date" to obtain the correct payment code (see Eli's HCW, Vol. XVI, No. 39).

CMS will instruct surveyors to give HHAs a pass on having the correct assessment day during that timeframe, in accordance with its guidance, Sevast assured attendees.

• If you have questions about flu vaccination administration, chances are CMS has answered them in its new MLN Matters article on the subject at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf. The majority of the 36,000 people who die in the U.S. every year from flu and its complications are 65 years or older, CMS notes in the article.

• You may want to rethink who you're gearing your Web site toward. Only 34 percent of people age 65 and older are online, notes the National Institutes of Health's National Institute on Aging. But the NIA wants to get more seniors on the Internet.

The agency has developed a free training curriculum for those who teach and work with older adults, according to a release. The toolkit at www.nihseniorhealth.gov/toolkit includes lessons plans, handouts, exercises, glossaries and classroom tips.