Home Health & Hospice Week

But Region D slowed, Region C in limbo thanks to protest.

In 18 states and the District of Columbia, "DMERC" will be an acronym of the past come July 1.

On that date, two durable medical equipment Medicare administrative contractors (DME MACs)--National Heritage Insurance Company Inc. and AdminaStar Federal--will each assume full responsibility for the work of their assigned geographic jurisdictions, taking over from the durable medical equipment regional carriers (DMERCs).

National Heritage will serve suppliers in Jurisdiction A, which includes Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachu-setts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. Its Web site is www.medicarenhic.com/dme/index.shtml.

AdminaStar Federal will serve suppliers in Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. Its Web site is www.adminastar.com/Providers/DMERC/ContractorReform/ContractorReform.html.

Contract disputes have held up the transition to the DME MACs in jurisdictions C and D, reports the Centers for Medicare & Medicaid Services (see Eli's HCW, Vol. XV, No. 9). But Noridian Admini-strative Services should be able to assume full responsibilities for the Jurisdiction D by the end of 2006.

"At the current time, no transition activity is occurring with respect to the DME MAC for Jurisdiction C, nor is there any activity with respect to implementing the four contract options," CMS says.

• It may get harder to figure out whether your contractor has received your appeal request, under newly manualized changes to the Medicare appeals process. CMS no longer requires intermediaries and carriers to send acknowledgement letters for requests for Hearing Officer hearings, CMS says in a June 16 transmittal (CR 5058).

The transmittal also makes other changes to the appeals portion of the Medicare Claims Processing Manual, including adding a question on overpayments to the reconsideration request form; eliminating contractors' requirement to notify Qualified Independent Contractors of effectuation amounts; and clarifying the Medicare Appeals Council's options in reviewing Administrative Law Judge decisions and dismissals.

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R985CP.pdf.

• Medical abbreviations kill thousands of people per year, according to the Food & Drug Administration. The FDA is joining with the Institute for Safe Medication Practices to stamp out providers' abbreviations on medical notes.

Among the killers are the letters "IU," which stands for "international unit" but could be mistaken for "intravenous." Also, your clinicians should write a zero before a decimal point, as in "0.4 ml." And it's easy to mix up "Q.D.," meaning once per day, with "Q.O.D.," meaning "every other day," the San Francisco Chronicle reports.

• If you leave the patient status code off a 34X TOB claim, expect it to bounce back to you. "Patient status codes must be entered on page 1 of a claim in the FISS and DDE systems for 34X Home Health Type of Bill and a 23X outpatient type of bill," regional home health intermediary Palmetto GBA explains in a posting on its Web site.

If you leave off the code, the claim will return to provider (RTP) with a 12101 or 31560 reason code indicating the missing patient status code, Palmetto says.

• A Maine physician repaid $200,000 to settle Stark self-referral charges that he referred patients to an oxygen company he owned, according to the HHS Office of Inspector General's semiannual report to Congress (see Eli's HCW, Vol. XV, No. 22).

The OIG recovered more than $1 billion from health care fraud and abuse in the first half of 2006, according the report available online at www.oig.hhs.gov/publications/docs/semiannual/2006/SemiannualSpring2006.pdf.

• Two Louisiana home care workers have been arrested on charges of Medicaid fraud. New Iberia residents Christina Mitchell and Mary A. Fuslier are charged with multiple fraud counts for submitting false claims to their employer, Unlimited Home Care in Villa Platte, according to a release from Attorney General Charles C. Foti, Jr.

Mitchell and Fuslier submitted claims for hours they didn't actually work, prosecutors charge. "UHC fully cooperated with this investigation," the release notes.

• The owner of 1st Choice Medical Supplies and Equipment pleaded guilty May 30 to multiple charges of Medicare fraud, according to the U.S. Department of Justice.

During his plea, Harold Iyalla admitted that as president of the Houston, TX-based DME firm, he engaged in a scheme to defraud Medicare by billing the program for motorized wheelchairs that were either not required by the beneficiary, not delivered or both.

• National Home Health Care Corp. showed mixed results for its latest quarter. The Scarsdale, NY-based provider's net income decreased to $722,000 for the quarter ended April 30, compared to $761,000 for the year-ago quarter.

But revenues increased 3 percent to $25.0 million for the quarter, compared to $24.2 million for the same period in 2005. NHHC credited the revenue increase to expanded business in New Jersey due to a May 2005 acquisition and expanded business in Mas-sachusetts and New York, according to a release.

• A scam to defraud Medicare beneficiaries is escalating. Callers are now asking for $379, up from $299, in exchange for providing a new Medicare card or prescription drug plan which are not legitimate, CMS warns. Callers ask for benes' bank account information to withdraw the money.
 
They may use the names of fictitious companies including Pharma Corp., National Medical Office, Medicare National Office and National Medicare, CMS cautions.