Home Health & Hospice Week

One assault down, probably more to go.

Home care providers heaved a sigh of relief when Congress announced its agreement on the State Children's Health Insurance Program bill--without the originally proposed cuts to home care reimbursement.

The SCHIP bill the House passed in August included a freeze on Medicare home health agency payment rates and cuts to oxygen and wheelchair reimbursement, while a bill the Senate also passed that month paid for SCHIP extension and expansion with tobacco tax increases only. The House eventually came around to the Senate's point of view.

However, to secure House legislators' backing on the SCHIP compromise, Senate leaders agreed to address Medicare legislation later this session, notes the National Association for Home Care & Hospice.

Likely scenario: The HHA and durable medical equipment cuts will be tempting solutions when lawmakers try to figure out how to find funding for averting the 10 percent Medicare payment cut to physicians. "NAHC will continue its grassroots campaign to stop Congress from including the home health payment freeze ... in whatever Medicare legislation emerges," the trade group pledges in its newsletter for members.

Fifty-nine senators and 163 representatives in the House have signed onto Dear Colleague letters opposing cuts to home care, NAHC points out. But the risk to 2008 home care reimbursement remains high this year, experts warn.

• Yet another new federal report is highlighting home health agencies' past woes with OASIS item M0175. The report, "Review of Medicare Payments to Connecticut VNA, Inc., for Home Health Services Preceded by a Hospital Discharge" (A-01-07-00501), looked at the agency's billing for 2004 and 2005.

Findings: The HHS Office of Inspector General identified eight claims that needed corrections that weren't caught automatically and recommends that CMS ensure the RHHI recoups the overpayments--a whopping $3,683.

To view the report, go to http://158.70.174.5/oiginternet/oas/reports/region1/10700501.pdf.

• If you're a DME supplier receiving NPI information edits, you'd better pay attention. Suppliers are frequently billing with National Provider Identifiers incorrectly, the Centers for Medicare & Medicaid Services warns in a message to providers. And that will lead to claims rejections instead of friendly edit messages quite soon.

Pitfall: Suppliers who "enumerate as individuals in the National Supplier Clearinghouse (NSC) ... must obtain NPIs for themselves as individuals (Entity type 1) in [the National Plan and Provider Enumeration System]. If they enumerate as organizations in the NSC, they must obtain NPIs for the organizations (Entity type 2) in NPPES," CMS instructs.

More edit information is at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf.

Don't forget: Your contractor may call you with NPI-related questions about a claim, CMS reminds suppliers. If you don't respond, the contractor will return the claim as unprocessable.

• The heat won't let up on hospice claims with organic brain syndrome coding any time soon. Regional home health intermediary Cahaba GBA will continue widespread medical review of hospice claims with diagnosis code 294.8 (Organic Brain Syndrome NEC) and a length of stay greater than 240 days. Cahaba made the decision after rejecting 61 percent of claims reviewed in a probe.

The problem: The majority of claims didn't document the six-month prognosis, the RHHI says. The intermediary denied another twenty percent of claims because the hospices didn't respond to the additional development requests (ADRs). And 12 percent of claims lacked election statements.

More information is at https://www.cahabagba.com/part_a/whats_new/20070918_hospice.htm.

• Palmetto GBA has revised its local coverage determinations for home health occupational therapy (LCD 02HH-0015-L) and speech language pathology (LCD 02HH-005-L) in light of diagnosis coding changes. The OT determination added these codes to the list that support medical necessity: 359.21, 359.22, 359.23, 359.24 and 359.29. It also included the codes expanded from 787.2: 787.20, 787.21, 787.22, 787.23, 787.24 and 787.29.

The SLP determination added these codes to the medical necessity support list: 315.43, 359.21, 359.22, 359.23, 359.24, 359.29, 338.45, 389.05-389.06, 389.13, 389.17, 389.20, 389.21 and 389.22. And it included 787.20-787.29, expanded from 787.2, Pal-metto explains.

• If you suspect other HHAs of swiping your patients, report them to your Program Safeguard Contractor (PSC). That's what RHHI Palmetto GBA advises an agency that allegedly saw a nurse quit and go to work for another agency, then that agency enrolled the nurse's former patients without explaining that they were switching to a new agency.

An HHA receiving a patient transfer must document that "the beneficiary has been informed that the initial HHA will no longer receive Medicare payment on behalf of the patient and will no longer provide Medicare covered services to the patient," Palmetto says in its Home Health Coalition Questions and An-swers for September. "The receiving HHA must also document in its records that it accessed the RHHI inquiry system to determine whether or not the patient was under an established home health plan of care and contacted the initial HHA on the effective date of transfer," Palmetto instructs.

The PSC for agencies served by Palmetto is TriCenturion. If you suspect "inappropriate practices may have taken place ... contact TriCenturion," the RHHI says. For a free copy of the Coalition Q&As, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Transfer Q&A" in the subject line.

• The National Institutes of Health has launched a diabetes education campaign that may help your patients. "Control Your Diabetes. For Life" em-phasizes prevention of cardiovascular disease.

"Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes," the NIH's National Institute of Diabetes and Digestive and Kidney Diseases says in a release. "And the risk for stroke is also two to four times higher among people with diabetes."

Tools such as patient tip sheets and provider pocket guides are available at www.ndep.nih.gov/campaigns/ControlForLife/ControlForLife_overview.htm.