Home Health & Hospice Week

More patients on anticoagulants will be able to manage at home, thanks to a new National Coverage Decision from Medicare.

Patients who are on warfarin and have mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (including deep venous thrombosis and pulmonary embolism) will now qualify for Medicare coverage of Prothrombin time (PT/INR) monitoring for home anticoagulation management, says a new NCD.

Currently, Medicare covers home PT/INR monitoring only for patients with heart valves, the Centers for Medicare & Medicaid Services notes in July 25 Transmittal No. 90 (CR 6138).

The change will take effect on Aug. 25, but will apply to claims with dates of service of March 19, 2008 and later.

The transmittal, which includes specific qualifying criteria, is online at http://www.cms.hhs.gov/transmittals/downloads/R90NCD.pdf.

• One MIPPA billing headache is gone for providers furnishing Part B services and equipment.

Durable medical equipment suppliers in the 10 competitive bidding areas won't be subject to OIG sanctions if they fail to charge beneficiaries their 20 percent copay based on the higher Medicare reimbursement rate mandated by the Medicare Improvements for Patients and Providers Act (MIP-PA). MIPPA delayed competitive bidding for 18 months and put in place rates that are lower than pre-bidding rates but higher than bidding rates.

Suppliers were worried they would have to go back and recalculate the copays based on the higher rates that went back into effect thanks to MIPPA. "Ordinarily, routine waivers of Medicare cost-sharing amounts potentially implicate the Federal anti-kickback statute, ... laws related to kickbacks , and the civil monetary penalty law prohibiting inducements to beneficiaries," the OIG acknowledges.

But in these specific circumstances, "Pro-viders will not be subject to OIG administrative sanctions if they waive Retroactive Beneficiary Liability" based on MIPPA rate changes, the agency says.

More details are online at http://oig.hhs.gov/fraud/docs/alertsandbulletins/2008/MIPPA_Policy_Statement.PDF.

• The New York Attorney General continues to crack down on home care insurance fraudsters. AG Andrew Cuomo won a lawsuit against insurance broker Thomas Piccirillo, requiring him to pay $500,000 in restitution to seniors he defrauded, $100,000 in penalties, plus an additional $10,000 penalty to the state for targeting senior citizens.

Piccirillo sold duplicative home care insurance policies to senior citizens, according to a release from the AG. In once case, Piccirillo sold overlapping insurance policies from Americare Home Care Services Inc. and Homeward Bound Services of North America Inc. to one elderly New York resident for $40,000 when the person didn't use any home care services.

Earlier this year, Cuomo's Office obtained an order requiring Homeward Bound Services and its owners to pay $100,000 in restitution for failing to honor agreements. The owners also were required to pay a civil penalty of $50,000 and costs of $12,000 to the state. As part of this order, Homeward Bound is barred from selling their Assisted Living Service Agreement for private duty care unless it posts a $1 million performance bond.

• CMS shouldn't throw out the baby with the bathwater when it comes to supplier accreditation, says the American Association for Home-care. The trade group is opposing CMS' recent announcement to drop the January 2009 accreditation deadline for suppliers in 70 competitive bidding areas (see Eli's HCW, Vol. XVII, No. 26, p. 204).

"Enactment of MIPPA is no reason to push back accreditation deadlines," says AAHomecare's Tyler Wilson in a release. "Accreditation for this industry is already 30 years overdue. If the federal government wants to get serious about preventing fraud ... it should use tools like accreditation more aggressively and use its ample, existing authority much more effectively."

• A new bill from Sens. John Kerry (D-MA) and Charles Grassley (R-IA) wants to rebalance Medicaid long-term care spending in favor of home care. "Home- and community-based services are high-quality, cost-effective, and help many people live independent lives, but Medicaid continues to favor nursing homes," Kerry notes in a release. "It's a problem when the nation's largest purchaser of long-term care services is tilted towards nursing homes rather than home- and community-based services."

Keeping seniors at home is "fiscally smart because institutional care is the most expensive form of long-term care that Medicaid pays for," Senate Finance chair Grassley notes in the release.

The "Empowered at Home Act" (S. 3327) would make Medicaid home care options more flexible, eliminate caps on enrollment and eligibility areas, apply spend-down limits to home care like they now apply to nursing homes, allow beneficiaries to keep more assets at home than in a nursing home and give tax breaks to caregivers and for long-term care insurance, among other provisions.

• A Wisconsin state appeals court has struck down a rule that tightened Medicaid eligibility for home care services. In 2005, the state's Department of Health Services told home care eligibility screeners to switch from considering a beneficiary's worst day in a month for determining eligibility to considering whether the person needed help one-third of the time, or 10 days a month, ac-cording to the Associated Press.

DHS should have made the policy change in a formal rule, the appeals court said in its July 24 ruling. Instead, the department just told the screeners to start doing it.

DHS argued it was an informal policy, but the appeals court agreed that it had the force of law for residents losing their eligibility, AP notes.

• Your Part B therapy services could start to look more like your Part A home care services, depending on a new research project commissioned by CMS. The agency has hired RTI International to investigate alternative payment strategies for Part B outpatient therapy, including developing a patient assessment tool that might resemble OASIS.

"The ultimate goal is to develop payment method alternatives to the current financial cap on outpatient therapy services," CMS says in a notice about the project and an Aug. 6 Special Open Door Forum about it. Providers can register for the forum at http://registration.intercall.com/go/cms2.

• MedQIC's home health quality tools will be moving to a new Web site this month. Information from http://www.medqic.com will move to www.qualitynet.org/MedQIC, notes Quality Improve-ment Organization Qualis Health in a posting on its Web site.

• Missing dates may be holding up your hospice claims at regional home health intermediary Cahaba GBA. "Hospice claims and notice of elections (NOEs) ... are suspended in status/location S MMIKE with reason code U5181," Cahaba reports. "This reason code indicates that an occurrence code (OC) 27 and date was required, but not included, or was included but reported an incorrect date."

You'll have to correct such claims when they return to provider (RTP), Cahaba instructs. Make sure "that OC 27 and the date are reported on all notices of election (NOEs) and initial claims following a hospice election," the RHHI stresses.

Tips on resolving this problem are at https://www.cahabagba.com/rhhi/claims/errors_u5181.htm.

• National chain Amedisys Inc. is crowing over its latest earnings. The Baton Rouge, LA-based for-profit recorded net income of $20.4 million on revenues of $312.7 million for the quarter ended June 30. That compares to a $14.9 million profit on revenues of $169.5 million for the same period in 2007.

Amedisys credits its massive acquisition of TLC Healthcare Services Inc. for the big jump in earnings, particularly revenues.

• Gentiva Health Services Inc. is touting its fall prevention program. In a survey of more than 10,000 patients who were treated in 2007 by the Gentiva Safe Strides home balance therapy program, 96 percent showed a reduction in their risk of falls between admission and discharge, the Melville, NY-based company says in a release.

Among the survey group, 95 percent were age 65 or older and 69 percent were women.