Home Health & Hospice Week

Panel explores payment by diagnoses.

A new Medicare payment system for home health could cut profit margins for some home health agencies, especially for large players, suggests an article in Inside CMS this month.

Abt Associates, a Cambridge, MA-based contractor that's has been working with the Centers for Medicare & Medicaid Services to refine the current payment system, has submitted its preliminary suggestions.

Proposed changes relate to home health case-mix adjustments, therapy visit thresholds and reimbursement for medical supplies, according to the publication.

The goal, says the agency, is to identify flaws in the current payment system, which hasn't been updated since its inception six years ago.

A technical expert panel appointed by CMS and Abt may recommend refining the home health resource group case mix system through diagnoses, according to a home health representative attending a March 14 TEP meeting.

Abt researchers report a number of areas where the case mix system could be refined, including home IV, parenteral and enteral therapy, pressure and stasis ulcers, multiple sclerosis, and type I and II diabetes with injectable drugs.

CMS will unveil the new payment system in this year's proposed home health agency payment rule, sources say. The new system could be implemented as soon as 2008. • An "unprecedented" effort to detect and prevent Medicaid fraud and abuse is in its early stages, announced the Centers for Medicare & Medicaid Services on July 18.

The goal is to halt theft, inappropriate use and simple mistakes that drain critical Medicaid program dollars, said the agency in a news release.

The new Medicaid Integrity Program (MIP) was created by the Deficit Reduction Act of 2005 with funds that will rise from $5 million in 2007 to $75 million by fiscal year 2009 and each year thereafter. Congress specifically required the use of contractors to review the actions of those seeking payment from Medicaid, conduct audits, identify overpayments and educate providers and others on program integrity and quality of care. Congress also mandated that the agency devote at least 100 full-time staff to the project, which will also be in collaboration with state Medicaid officials.

"A comprehensive and systematic approach to combating the misuse of taxpayer funds is key to helping lower health care costs for Medicaid beneficiaries," said Mark McClellan, CMS administrator. • If you're a durable medical equipment supplier, you may need to resubmit claims with code K0108 (wheelchair component or accessory, not otherwise specified). National Heritage Insurance Company, the DME Medicare Administrative Contractor in Jurisdiction A, reports that the code has been rejected in error as "procedure code invalid for date of service." The problem was corrected July 17.

Jurisdiction A includes Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode [...]