Home Health & Hospice Week

Keep an eye out for early legislative developments that could put you at risk.

Congress can't agree on much this year, but legislators do seem to want to move forward on a fix for physicians' Medicare payment rates--and that could put your own Medicare reimbursement at risk.

In December, Congress passed and President Bush signed into law a Medicare package that averted docs' 10 percent pay cut under Medicare. Home care providers pulled out a victory by avoiding cuts to their own 2008 rates, despite heavy consideration of such reductions by lawmakers.

But the current legislation staves off the cut only until July 1. That means lawmakers will have to put together another Medicare package before then to avoid the cut again. And they will be looking for likely sources of funding for the fix--especially home health agencies and durable medical equipment suppliers. The Medicare Payment Advisory Commission's forthcoming recommendation to freeze Medicare rates in 2009 won't help agencies' case.

Some observers predict that Congress will hold off on a Medicare package until after the November elections. Getting anything passed in an election year is a big challenge, they note. Such a post-election package would include retroactive pay increases for physicians to make up for the months of reduced Medicare rates, they say.

But others think there is enough political momentum to pass a physician fix--and thus other provider payment provisions--before the July 1 cut takes effect.

Watch for: President Bush is expected to unveil his proposal for a broader physician formula fix in his State of the Union address Jan. 28. And the Administration will include the measure in next month's 2009 budget proposal.

• If you're having trouble getting your referring physicians' National Provider Identifier (NPI) numbers, don't despair. The Centers for Medicare & Medicaid Services has relented and given providers a work-around when they just can't obtain NPIs from their referring docs, according to Jan. 18 Transmittal No. 235 (CR 5890).

"After several attempts to obtain the NPI" from the ordering/referring provider, providers "can report their own name and NPI in the ordering/referring ... provider fields of the claims," CMS says in the memo.

"Contractors shall accept the supplier's own name and NPI in the ordering/referring ... provider fields, effective for claims with dates of receipt on or after May 23, 2008," CMS states. But home health agencies, hospices and durable medical equipment suppliers will have to do the substituting themselves--Medicare contractors won't automatically fill the field with the primary provider's NPI, the memo instructs.

And CMS still expects providers to make every effort to obtain NPIs, it makes clear in a related MLN Matters article.

The memo is at www.cms.hhs.gov/transmittals/downloads/R235PI.pdf. The MLN Matters article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5890.pdf.

• The feds' latest count of bids from round one of competitive bidding is 6,300. That number comes from Herb Kuhn, CMS acting deputy administrator, according to a recent issue of The Hill, a newspaper focusing on congressional news.

The second round of competitive bidding, announced earlier this month, will add 70 new competitive bidding areas to the first 10 areas.

• Home care concerns are getting national attention thanks to the 2008 presidential race. Repub-lican contender John McCain is citing home care as an important election issue.

"We need to encourage home health care," Sen. McCain (R-AZ) said in a Jan. 14 campaign event in Michigan. "We, in Arizona, have a system ... that encourages health care providers to provide home health care, which many of us believe is a much better setting than a long-term facility."

"Because we've put in those incentives, on a per-capita-basis we have half the number of people in long-term care facilities as in the state of Pennsylvania," McCain noted.

• Don't be surprised if you see a new FISS log-in screen from intermediary National Government Services. "Your login screen will now display a banner that says 'CMS Menu' instead of 'EDS NET,'" NGS explains in a message to providers. Your Fiscal Intermediary Shared System login and password will stay the same.

• Starting Feb. 1, intermediary Palmetto GBA will limit your Provider Contact Center inquiries to three per call, it says in a message to providers. The contractor is adopting the limit to "maintain accurate tracking and reporting," it says.

• Are your employees who you think they are? A Long Island home health agency recently agreed to pay $170,000 to a former client whose home care aide turned out to be a transvestite, according to the New York Daily News.

All Metro Home Care made the settlement in the midst of a civil trial regarding former home care worker Jonathan (Tracy) Uzzell. Five weeks into Uzz-ell's job caring for 84-year-old Clara Migden, Uzzell ransacked her apartment, stole her bankcard and went missing, Migden maintained.

Police arrested Uzzell and discovered during the booking process she was actually a transvestite with arrests for prostitution, crack cocaine and stabbing a teenager in 1991, according to the newspaper. Uzzell did 18 months in state prison for the Migden theft, and was released in 2003.

• If you furnish Medicaid-covered home care in Florida, get ready for scrutiny. Florida's Agency for Health Care Administration has uncovered dozens of providers billing for millions in unnecessary or never-performed services, according to The Miami Herald. The AHCA is sharing the information with the state Attorney General's office for possible enforcement.

"What we found in the last week is just the tip of the iceberg," AHCA's Andrew Agwunobi told the newspaper.

Example: One provider said she cared for three patients in Homestead, two in Hialeah and two more in Little Havanna all on the same day.

The home care crackdown comes on the heels of news that the state's Medicaid Fraud Control Unit recovered about $5 million less in 2007 than 2006--a total of $134.3 million, according to the Tampa Bay Business Journal.

• The fight against HME competitive bidding has taken a surprising new twist. VGM, Invacare and the National Association of Independent Medical Equipment Suppliers are among the groups that in recent days have spoken out publicly against the New Braunfels, TX-based Scooter Store.

The Scooter Store critics charge that the supplier, which bills Medicare more than $100 million annually, recently engaged in a letter writing campaign to Congress supporting the retention of complex rehab products within competitive bidding-a stand that's contrary to most in the industry.

"Their message is clear and concise," reads a Jan. 15 letter from VGM to the American Association for Homecare. "[The Scooter Store's] intent is to actively and aggressively promote Competitive Bidding nationwide and include both consumer power products along with complex rehab in the bid categories." VGM has asked AAHomecare to remove the Scooter Store from its Rehab and Assistive Technology Council.

Days later, Elyria, OH-based Invacare Corp. announced that it would no longer do business with the Scooter Store, a move that NAIMES lauded.

"NAIMES applauds the stand that the Invacare Corporation has taken in unity with independent equipment suppliers by announcing their decision to cease doing business with The Scooter Store," the group says in a press release.

A bill in the House, the Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2007 (H.R. 2231), would amend the Social Security Act to exempt complex rehabilitation products and assistive technology products from the Medicare competitive acquisition program.

• A former leading home care consultant died Jan. 10 after a long battle with cancer. Lisa Thomas-Payne of Albuquerque, NM-based Medical Reimbursement Systems was often quoted by Eli. She founded the Colorado Association of Medical Equipment Suppliers among other professional accomplishments, according to the Albuquerque Journal. Thomas-Payne was 46 and left behind two sons and a longtime partner.

"She is the most inspirational person I have ever known," friend Valerie Turner told the newspaper. "She was just tremendous." Thomas-Payne liked to race cars and volunteer for charities. And she counseled other cancer patients on treatments and end-of-life issues.