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Home Health & Hospice Week

Industry Notes:

M0175 Takebacks Pegged At $4,000 A Piece

Published on Thu Nov 20, 2003

How accurate is your OASIS data on patients' prior hospital stays? 

Are you ready to fork over thousands of dollars for something that wasn't your fault?

Retroactive recoupments for incorrect answers to OASIS item M0175 are estimated to cost home health agencies $4,000 per agency, the Centers for Medicare & Medicaid Services said in its Nov. 5 Open Door Forum for home health.

Of course, the actual takeback amount will depend on how often HHAs incorrectly reported a skilled nursing facility or rehab stay without reporting an additional hospital stay in the 14 days preceding admission or resumption of care (see Eli's HCW, Vol. XII, No. 39, p. 306).

"We're not going to close anyone's doors," with the M0175 takebacks, one CMS official said in the forum.

  • CMS is putting its money where its mouth is when it comes to disease management.

    The agency will fund a one-year pilot project to test whether disease management for various forms of heart disease and diabetes saves the Medicare program money and improves patient outcomes.

    Rosemont, IL-based CorSolutions, Baltimore, MD-based Diabetix/XLHealth and Santa Ana, CA-based HeartPartners SM will enroll 30,000 chronically ill beneficiaries in California, Arizona, Louisiana and Texas in DM programs.

  • The HHS Office of Inspector General is back on track after a flood of senior staff departures and reports of poor management under controversial ex-IG Janet Rehnquist. So said Acting Principal Deputy IG Dara Corrigan at a Nov. 10 "meet-and-greet" with the newly appointed official.

    "You can have a rocky period in any organization, but it's important to get back to doing your work," Corrigan said. Among top agenda items are medical-necessity cases and an examination of the effectiveness of CMS' enforcement tools.

    Corrigan, who previously headed the CMS Office of Program Integrity, says she welcomes provider input, but only if providers state facts and don't whine. "When they start telling me that it's impossible to write in the medical chart, 'I was there,'" she's unimpressed. "Give it to me straight, and then we'll play fair in response."

    Corrigan is considered a potential permanent replacement for Rehnquist, but it's unclear when or with whom the White House will fill the slot.

    be contributing to patient safety problems, the Institute of Medicine says in its latest study, Keeping Patients Safe: Transforming the Work Environment of Nurses.

    "Home care nurses are estimated to spend a much greater proportion of their time in documenting care," the IOM notes. Studies estimate "these nurses spend twice as much time in documenting patient care as do hospital nurses, in part because of more prescriptive federal regulatory requirements for documentation in home health care than in hospital care."

    The influential IOM recommends redesigning nurse work environments and care processes to reduce errors, including mistakes related to "completing redundant and unnecessary documentation."

  • A PACE pioneer has become the newest permanent provider under the Program of All-Inclusive Care for the Elderly. San Francisco, CA-based On Lok Senior Health Services helped launch the PACE demonstration project back in 1983, and the provider now coordinates services for about 970 frail seniors in San Francisco and Freemont, CMS says in a release.

    Under PACE, providers received a fixed monthly amount to furnish medical and social services for dually eligible Medicare/Medicaid beneficiaries who qualify for nursing home stays, but want to stay at home.

  • A Dallas-based for-profit hospice chain has acquired another hospice in its own state. Odyssey HealthCare Inc. has acquired San Antonio, TX-based Hospice Home Care for an undisclosed amount. Odyssey will incorporate Hospice Home Care's operations and patients into its existing San Antonio location, it says.

  • American HomePatient Inc. continues its legal battles over whether its lenders or its shareholders will control the company.

    After a series of court decisions affirming AHP's bankruptcy plan, including shareholders' retained interest in the respiratory, infusion and durable medical equipment company, its secured lenders have filed another appeal. AHP intends to contest the appeal, filed Oct. 14 with the U.S. Court of Appeals for the Sixth Circuit, and "to vigorously defend the confirmation order entered by the Bankruptcy Court and upheld by the District Court," it says in its latest earnings report.

    AHP, which emerged from bankruptcy July 1, reported net income of $400,000 on revenues of $83.9 million for the quarter ended Sept. 30, compared to a $2.4 million loss on $79.0 million in revenues for the same period in 2002.

  • The battle over whether to establish a state-run home care system in New Jersey rages on. The Coalition for R.E.A.L. Home Care in New Jersey held a Nov. 13 press conference to protest a bill that proposes a system based on the one in California, where state councils assign aides to patients (see Eli's HCW, Vol. XII, No. 23, p. 183).

    California's system is flawed, with out-of-control spending, lack of oversight and fraud and abuse, the coalition claims. And the move would hurt quality and take money away from aides themselves, it argues.

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