Home Health & Hospice Week
Medicaid Sets Its Sights On Drugs
Big changes in Medicaid fraud scrutiny could mean big changes in drug pricing. Medicaid rebates and drug pricing issues are heating up, and drug manufacturers are examining their practices to set things right. The latest example: Bristol, TN-based King Pharmaceuticals says it's adjusting its financial statements to reflect about $46.5 million in Medicaid overpayments between 1998 and 2002. That adjustment arose from an internal review by the audit committee of King's board of directors - a review that a Securities and Exchange Commission investigation sparked. The company says the adjustment relates to amounts it underpaid Medicaid under the Medicaid rebate program and other government drug pricing regimes. King has contacted the HHS Office of Inspector General, the Department of Justice and the Centers for Medicare & Medicaid Services on the matter, and expects to resolve it later this year. King isn't the first drugmaker to start looking into its compliance practices. Bristol-Myers recently launched an internal compliance review of its sales and marketing tactics. King says it is putting in place more aggressive compliance measures - including new information technology applications - to improve the accuracy of its rebate payments.
Version 1.05 of the HH PPS case mix grouper software, which accommodates changes in OASIS reporting requirements, takes effect Oct. 1. In addition to the software, CMS also has posted grouper coding logic (pseudocode), test records and demonstration programs. CMS explains how to furnish - and bill for - covered diabetes outpatient self-management to eligible Medicare beneficiaries, according to a recent revision to the Medicare Home Health Agency Manual. But there is a catch: Home health agencies have to be willing to bill for the training services under Part B of Medicare. That means going by the same rules that durable medical equipment suppliers, physicians and other Part B providers follow, including collecting copays, CMS explains in Aug. 1 Transmittal No. 305. For coverage and billing details on diabetes outpatient self-management training, see the memo at www.cms.gov/manuals/pm_trans/R305 HHA.pdf. Palmetto offers these three helpful hints to avoid denials for late or missing documentation in response to an ADR: 1) Monitor your claim status on direct data entry (DDE). If the claim is in status SB6001, the claim has been selected for review and you must submit records. 2) Be aware of the ADR date and the need to submit medical records within 30 days. 3) Return the medical records to the address on the ADR. Include the appropriate mail code to ensure your responses are promptly routed to the Medical Review Department. The demo applies to Connecticut claims from fiscal year 2001 through FY 2005. But Massachusetts and New York claims from FY 2000 through FY 2004 will be affected, CMS clarifies. In a July 25 letter to Department of Health and Human Services Secretary Tommy Thompson, AHIMA calls for a fast-track adoption of International Classification of Diseases - 10th edition in the U.S. health care system. The decades-old ICD-9 is long out of date, AHIMA Chief Executive Officer Linda Kloss maintains in the letter. All other major developed countries use ICD-10, she adds. While this has been a long-running battle, AHIMA does have some interesting news for coders who worry that ICD-10-CM (clinical modifications) and ICD-10-PCS (procedure coding system) are too complex. Field tests conducted by AHIMA and CMS have shown that not only is ICD-10 not too complex for coders, but also that the improved specificity of the systems actually helps coders and results in more accurate data, the group maintains. You must be able to send and receive HIPAA-compliant electronic transactions by the Oct. 16 deadline, CMS reminds providers. The cost of rolling out Option Care's information system and bad debt expenses related to the company's Texas operations offset the higher revenues, the company says. Option Care's Texas operations had a days' sales outstanding of 160 days while the rest of the company's DSO was 67 days, Option Care President and COO Rick Smith says in a release. Option Care is focusing on remedying the receivables problems in Texas, it assured investors. Dallas-based Odyssey acquired hospice programs in Brownsville, TX and Wilmington, DE Aug. 1, adding about 75 patients to the company's rolls. During the quarter, Odyssey's hospice programs in Philadelphia and Portland, OR received Medicare certification. The company's average daily census for the quarter was 5,758 patients, an increase of 34 percent over the second quarter of 2002. Days of care for the quarter increased 34 percent to 523,967 during the same period, Odyssey says. A U.S. Bankruptcy Court for the District of Delaware judge is slated to hear the competing plans Sept. 9, says the Deal. Coram has been in bankruptcy for about three years.
Home Health & Hospice Week
- Benchmarking:
Private Pay Rates Increase 3 Percent In 2003
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Indiana Providers Have Right To Survey Review, Court Says
State sureryors not above the law, recent decision shows Home health agencies frustrated with their [...] - Fraud & Abuse:
Medicaid Probe Drives Supplier Out Of Business
DME suppliers should repeat this mantra: documentation, documentation, documentation A recent investigation focusing on three [...] - Finance:
Home Care Players See Smaller Profits
Gentiva's revenues are up while Amediss' are down for this quarter Medicare cuts are taking [...] - Industry Notes:
Medicaid Sets Its Sights On Drugs
Big changes in Medicaid fraud scrutiny could mean big changes in drug pricing. Medicaid rebates [...] - Post-Acute Care:
More Hospital DRGs Subject To Post-Acute Transfer Proration
Hospitals now will have 29 rather than 10 diagnosis related groups that Medicare will [...]
