Home Health & Hospice Week

CMS promises safeguards to ensure error rate accuracy.

Medicare continues to pay providers more accurately, according to a new report.

The improper payment rate for Medicare fee-for-service providers dropped from 3.9 percent last year to 3.6 percent in 2008, the Centers for Medicare & Medicaid Services says in the latest comprehensive error rate testing (CERT) report. That translates to $10.4 billion in incorrect payments to FFS providers for the year, CMS says in a release.

"For Medicare FFS, most improper payments are due to claims for services that were medically unnecessary or incorrectly coded," CMS says.

For the first time, CMS calculated error rates for the Medicare Advantage, Medicaid, and SCHIP programs. MA payments reached a 10.6 percent error rate in 2007, Medicaid payments were 10.5 percent, and SCHIP payments 14.7 percent. Those higher rates were largely due to lack of documentation, the same problem CMS had in calculating FFS rates before major education efforts, the agency notes in a release.

Safeguard: This year's CERT report comes after the HHS Office of Inspector General blasted CMS and its CERT contractor for low-balling durable medical equipment payment error rates in 2006. Instead of the reported error rate of 7.5 percent, the rate should have been more like 30 percent, the OIG claimed (see Eli's HCW, Vol. XVII, No. 31, p. 242). The report set off a firestorm of political and public scrutiny that embarrassed the industry and CMS.

CMS response: "To strengthen confidence in the accuracy of reported error rates, CMS also announced it is conducting an in-depth evaluation effort to review this year's Medicare FFS error rate," the agency says in its release.

At press time, CMS hadn't yet posted the full report and provider-specific error rates. The 2008 report will be at http://www.cms.hhs.gov/CERT.

• The cost of diabetes continues to climb, as does the number of people who have it. Diabetes in 2007 cost the U.S. $218 billion in direct medical care and indirect costs, according to a report authored by the Lewin Group and commissioned by diabetes drug manufacturer Norvo Nordisk.

The $218 billion accounts for about 10 percent of all U.S. health care spending by the government and public, says the Associated Press.

"Diabetes has not seen a decline or even a plateauing, and the death rate from diabetes continues to rise," Dana Haza, of the National Changing Diabetes Program launched by Norvo, tells AP. "The numbers just keep going higher and higher."

• If you furnish adult vaccinations, CMS has a reference tool for you. An updated brochure at http://www.cms.hhs.gov/MLNProducts/downloads/Adult_Immunization.pdf provides an overview of Med-icare's coverage of influenza, pneumococcal, and hepatitis B vaccines and their administration, CMS explains in a message to providers.

• Almost Family Inc. credits its "thoughtful and deliberate approach to acquisitions" for its rosy earnings in the most recent quarter.

The Louisville, Ky.-based regional chain reports $4.7 million in net income on $58.7 million in revenues for the quarter ended Sept. 30. That compares to a $1.9 million profit on $32.0 million in revenues for the same period in 2007.

"The results absolutely crushed analysts' predictions," praises stock analyst Elizabeth Har-row with Schaeffer's Investment Research.

Almost Family closed its acquisition of eight-location Patient Care Inc. Aug. 1, the company says in a release.

• Trying to keep up home health aides' wages has put one Washington home health agency under. Seattle-based anti-poverty advocacy group Solid Ground is closing the doors of its home care program Dec. 31, it says in a release.

"For years, Home Care has cost more to operate than we receive in contracts for its services -- due to the fact that we have consistently paid our community aides the highest wages in Washington State," Solid Ground executive director Cheryl Cobbs says in a release.

"As an anti-poverty agency, it has been critical for us to pay a living wage for this vital work," Cobbs continues. "The disturbing reality is that our society does not place enough value on taking care of our elders and people with disabilities in their own homes to make this work sustainable," she says.

"This has been a dilemma for Solid Ground for two decades, trying to keep the home-care program going and at the same time offering decent wages," Cindy Schu of the OPEI Union Local 8 tells the Seattle Times. "They've had a commitment to doing that, and they just weren't able to do it any longer. It's sad."

Solid Ground's patients and staff will transition to other providers before the closure date, it says.

• A jury has convicted former durable medical equipment supplier Eduardo Batista Barquin of fraud, says R. Alexander Acosta, U.S. Attorney for the Southern District of Florida.

Batista, who controlled and operated Amer-ica Medical Services & Supplies Inc. in Miami, caused the submission of $3.5 million in false claims to Medicare for DME items and services that were not prescribed by doctors or provided as claimed, Acosta says in a release.

Batista is scheduled for sentencing next month and could face up to five years in prison, reports The Miami Herald.

• Power mobility device company The Scooter Store has inked new agreements with 17 insurance companies to furnish power wheelchairs and scooters, the New Braunfels, Texas-based supplier says in a release.

The contracts, which include Medicare Advantage and Medicaid beneficiaries, cover members in Pennsylvania, Washington, Michigan, and New York, The Scooter Store notes. The company has 125 partnerships with health plans in all.

• If Cahaba GBA is your intermediary, get ready for a new way to access the Fiscal Inter-mediary Shared System (FISS) for Direct Data Entry (DDE).

Providers that use WebSphere Host On Demand must now contract with a third party for connectivity to FISS, Cahaba explains in a message to providers. Two Network Service Vendors, IVANS Inc. and VisionShare Inc., "are hosting a series of webinars to help providers understand their new options for FISS/DDE access and how they can easily transition to these new solutions," Cahaba says.