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Home Health & Hospice Week

Industry Notes:

Medicare Increases Beneficiaries' Part B Costs

Published on Thu Sep 09, 2004

Enrollees will have to pay more for DME.

A sharp increase in Medicare Part B premiums and deductibles is on its way in 2005 - the first increase in premiums since 1991.
 
Beneficiaries can expect premiums to rise by 17 percent next year, the Department of Health and Human Services announced Sept. 3. And three-fourths of that hike is attributable to additional Part B costs rung up under the Medicare Modernization Act.
 
Your patients can expect a monthly Part B premium increase of $11.60 to $78.20, up from $66.60 in 2004, HHS says.
 
For Medicare Part A, the deductible for 60 days of inpatient hospital coverage will be $912, up $36 from $876. Part B will increase to $110.
 
The premium and deductible increases coupled together were a "double whammy for America's 40 million Medicare beneficiaries," says Rep. Pete Stark (D-CA), ranking member on the House Ways and Means Health Subcommittee. Centers for Medicare & Medicaid Services Administrator Mark McClellan says the hike is part of creating an "enhanced Medicare."

 

  • Acute care hospitalization and emergent care utilization are two home health outcomes slated for special focus over the next three years. CMS has selected these two OASIS quality measures for Quality Improvement Organizations to work on in their next three-year contract cycle that started last month, according to the draft "8th QIO Scope of Work" for the QIOs.
     
    At least 20 percent of HHAs also have to pick two other quality measures to focus on and meet or exceed the national target rate for those measures, the draft explains. The proposal is online at     www.cms.hhs.gov/qio/2s.pdf.

     

  • Electrical stimulation and electromagnetic therapy for wound treatment do count toward M0825, a letter from CMS to the National Association for Home Care & Hospice confirms. "EM and ES must be provided by a physical therapist or a physician," CMS told NAHC in a recent letter. But the national coverage decision on the therapies "does not exclude the home as a setting where these services can be provided as long as all other criteria are met."
     
    The treatment still must meet the rather stringent coverage criteria, CMS reminds providers (see Eli's HCW, Vol. XIII, No. 12, p. 92).

     

  • A claims remark code about parenteral pumps will get less confusing this month. Durable medical equipment regional carriers have been putting remark code M6 on claims for parenteral pumps. The message reads, "You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period."
     
    The problem is that Medicare actually covers maintenance and servicing every three months for parenteral pumps, CMS notes in an Aug. 27 transmittal (Change Request 3405). So starting Sept. 27, DMERCs will begin using a new remark code for the pumps, N218. The new code will say, "for the time period specified in the contract or coverage manual" instead of six months.

     

  • Fallout from Operation Wheeler Dealer continues to plague the industry, including The Scooter Store. The New Braunfels, TX-based company has laid off 200 more workers due to "the continuing impact of restrictive Medicare policies," CEO Doug Harrison says in a release.
     
    The layoffs are part of a company restructuring aimed at "preserving the company's stability through a time of industry change and challenge," it says. The company laid off about 200 workers in January and has an FBI probe pending against it.
     
    The DMERCs continue to make wheelchair coverage decisions based on the coverage criteria "clarification" that CMS supposedly rescinded (see Eli's HCW, Vol. XIII, No. 12, p. 92), the Scooter Store charges. "The Scooter Store actively is appealing denied claims worth millions of dollars in Medicare reimbursements for power wheelchairs already delivered that were prescribed by patients' personal physicians," President Mike Pfister says in the release.
     
    The company continues to employ about 1,000 workers, it says.

     

  • Southeastern regional chain Amedisys Inc. is strengthening its presence in the Mid-Atlantic. Amedisys has acquired a three-location HHA based in Richmond, VA from Freedom Home Health for undisclosed terms, the Baton Rouge, LA-based company says.
     
    The acquisition will contribute about $6.5 million in annual revenues starting next year, Amedisys expects. And the company continues to be on the lookout for multi-site agencies to acquire, it adds.

     

  • Augusta, GA-based First Choice Medical has sold its personal care and skilled nursing service businesses to Louisville, KY-based ResCare Inc., but it's retaining its respiratory, home medical and home infusion lines. First Choice Medical's home care services will become a part of Southern Home Care Services, a ResCare subsidiary that provides in-home services in Georgia and South Carolina, ResCare says.

     

  • Louisiana HHA chain Synergy Inc. has acquired three new locations in Lafayette (Our Lady of Lourdes Home Health), Alexandria (Rapides Regional Medical Center Home Health) and Ruston (McCullen Home Health) for undisclosed terms, the Associated Press reports. The company now has 14 locations and employs about 50 people.

     

  • Ohio HHA chain Cambridge Home Health Care has opened its 21st office, in Huber Heights. Akron-based Cambridge serves more than 2,000 home care patients a week with 1,425 employees.

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