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 [...]