Home Health & Hospice Week

CERT success evident to GAO.

The federal government spent $7 billion less in improper payments in 2005 than in 2004, according to the Government Accountability Office. And this reduction was largely thanks to a reduction in wasteful Medicare spending.

The catch: The GAO says this improvement mostly came from a change in how Medicare estimated improper spending, not from any "improved payment controls."

"When providers do not submit documentation to justify payments received, these payments were counted by [the Department of Health and Human Services] as erroneous," the GAO notes.

But the fact that HHS has made greater efforts to obtain documentation from providers doesn't mean that errors have decreased. Medicare has done a better job of educating providers about the Comprehensive Error Rate Testing program and the importance of responding to questions (see Eli's HCW, Vol. XIV, No. 13).

HHS still blamed Medicare for the biggest part of its improper payments, with an estimated $12.1 billion in waste for 2005.

HHS hasn't yet figured out how to report improper spending in Medicare managed care, according to the GAO's report, "Improper Payments: Agencies' Fiscal Year 2005 Reporting Under The Improper Payments Act Remains Incomplete" (GAO-07-92).

• Congress won't be passing a fix for a 2007 physician payment cut this year, experts predict. That likely lets home care off the hook as a source for funding the fix to the 5 percent cut.

But providers shouldn't celebrate their 2007 Medicare rate increase just yet. "The physician payment issue will come up next year if not addressed in the lame duck [session]," cautions the American Association for Homecare.

"Providers should remind Congress to resist any more assaults on home oxygen therapy, home health, and other cost-effective forms of home care during the final weeks of the 109th Congress and next year," AAH urges in a message to members.

• Home health agencies that continue to find home health advance beneficiary notices confusing can turn to new resources for help. Regional home health intermediary Cahaba GBA has added two new articles on ABNs to its educational listings for HHAs. "HHABNs and Billing Processes for Denial" and "HHABNs and Reduction in Care" are available at https://www.cahabagba.com/part_a/education_and_outreach/educational_materials/index.htm under the "Home Health Quick Reference Tools" section.

• The Medicaid program should rewrite Medicaid law to encourage the use of home care services, the Medicaid Commission is recommending to law- and policymakers.

The commission, appointed by HHS Secretary Michael Leavitt last year, adopted the suggestions as one of its cost-cutting recommendations for Medicaid, reports The New York Times. The panel next will send a report containing its recommendations to Leavitt. The report will also endorse using managed care plans to coordinate care for the sickest Medicaid beneficiaries.

But Bush administration adversaries are already striking out at the plan's suggestions. Rep. John Dingell (D-MI), who is in line to become chairman of the House Energy and Commerce Committee, dismissed the panel as "a hand-picked commission stacked against working families," according to the Times.

• You're allowed to submit National Provider Identifiers on claims by themselves, but you should keep submitting old provider numbers along with them anyway, the Centers for Medicare & Medicaid Services says in Transmittal 249, dated Nov. 13. While the contractors are still testing systems, you risk having your NPI-only claims denied.

• Pediatric Services of America Inc. has agreed to acquire the pediatric nursing assets of Americare at Home Inc. PSAI's pediatric nursing division, PSA Healthcare, will buy the Shrewsbury and Newton, MA locations for $1.4 million, the Norcross, GA-based company says. Annual net revenue for the operations is $2.7 million.

"We are excited to further expand our presence in the Massachusetts market through this acquisition," PSA CEO Daniel J. Kohl says in a release. "We continue to evaluate a number of opportunities available in attractive markets and remain focused on executing our acquisition strategy within the private duty nursing segment."

• Amedisys Inc. netted about $117.9 million from its latest stock offering, the Baton Rouge, LA-based regional chain says in a release.

The company used $43.2 million of the proceeds to pay down debt. Amedisys plans to use the rest "for general corporate purposes, including working capital and possible acquisitions," it says. The company may see another $17.7 million if over-allotment stock options are exercised over the next month.

• Odyssey Healthcare Inc. plans to repurchase $10 million in stock over the next 12 months, the for-profit hospice chain says in a release.

The Dallas-based company also received Medicare certification for its Bryan-College Station, TX program this month, it says.