Home Health & Hospice Week

Don't list V57 as secondary.

If you're wondering whether you can use V57.x for patients that receive therapy and other discipline visits, you'll have to wonder a while longer.

The Centers for Medicare & Medicaid Services has issued new guidance on diagnosis coding in light of the V code changes that took effect Dec. 1, 2005. Coding guidelines changed so that some V codes, including the popular V57.x (Care involving use of rehabilitation procedures), can be listed as a primary diagnosis only (see Eli's HCW, Vol. XIV, No. 45).

CMS reminds home health agencies to check out the new primary diagnosis-only requirements. HHAs shouldn't have to change much--they should choose their primary and secondary diagnoses as they always have, except to avoid those primary diagnosis-only V codes as secondary diagnoses, CMS says.

Agencies should use V codes "when a person with current or resolving disease or injury encounters the health care system for specific aftercare of that disease or injury," CMS adds. Don't use V codes when specific codes for medical or surgical complications would work better, CMS cautions in the guidance at www.cms.hhs.gov/HomeHealthPPS/downloads/v_code_rev_stmt2.pdf.

The National Association for Home Care & Hospice is disappointed that CMS' guidance doesn't contain one major clarification--whether V57 is appropriate only for cases with therapy visits and no nursing or other discipline visits. "Some coding experts took the position that because of the December changes, home health providers are limited to using V57 codes ... in therapy-only cases," NAHC notes.

• CMS is asking physicians and treating practitioners to hold certain power wheelchair or scooter claims until April 1.

The Medicare Modernization Act of 2003 requires docs to submit parts of the medical record along with the wheelchair or scooter prescription to durable medical equipment suppliers, CMS explains in a fact sheet at www.cms.hhs.gov/apps/media/press/release.asp?Counter=1780.

Physicians will receive a separate payment of $21.60, billable with code G0372 (Physician service required to establish and document the need for a power mobility device), in addition to the payment for the office visit to recognize the additional work involved.

CMS implemented these changes through an interim final rule, effective in October 2005, but Congress has directed Medicare to wait until April 1 to implement the rule.

Physicians can (1) continue to submit the G0372 code and evaluation and management (E/M) on the same claim. Carriers will hold payment for these claims until after April 1; (2) hold all claims containing the G0372 code until after April 1; or (3) submit the E/M service now and bill the G0372 code after April 1. Carriers will pay the E/M service now and the G0372 code after April 1.

After April 1, docs must bill the E/M and G0372 code on the same claim, CMS says. And physicians shouldn't forget to bill their Part B carriers for the codes, not the DME regional carriers, CMS reminded in a recent Open Door Forum (see Eli's HCW, Vol. XV, No. 1).

• A typo in the version of the Deficit Reduction Act (S. 1932) that the House of Representatives approved has prompted speculation about the status of the bill, the American Association for Homecare notes. The typo put the rental period for items in the existing home medical equipment capped rental category at 36 months instead of the 13 months agreed to by the House and Senate, AAHomecare says.

On Feb. 8, President Bush signed the corrected version of the bill, and the Senate passed a resolution (S. Con. Res. 80) affirming that the President signed the bill that reflects the true intent of Congress, AAHome-care says.

Congressional sources told AAHomecare that the House needs to "square the language it passed with the version the President signed."

Opponents of the DRA hope to use the discrepancy to invalidate it, but experts doubt such far-reaching results will occur. Legal challenges to the law's provisions may arise, however.

• Even though home health agencies are saying goodbye to the 2006 payment rate update, they can't say farewell to CBSAs The one-year transition to the new labor market designation of core-based statistical areas is still taking place, CMS emphasizes in Feb. 10 Transmittal No. 211. This year, agencies have a 50 percent CBSA/50 percent MSA wage index (see Eli's HCW, Vol. XIV, No. 45).

CMS also will stick with lowering the fixed dollar loss ratio for outlier payments from 0.70 to 0.65, according to the transmittal. That change should make it a bit easier for agencies to qualify for outlier payments (see Eli's HCW, Vol. XIV, No. 39).

• HHA chain Intrepid U.S.A. has shelled out $8 million to settle charges of fraudulent billing and false claims, the Department of Justice notes in a release. The feds accused Edina, MN-based Intrepid of overbilling Medicare, Medicaid and TRICARE/ CHAMPUS from 1997 to 2004 for services not provided by a qualified person and for services not supported by complete documentation, among other violations. The government also alleged false claims in 2002 and 2003 when Intrepid billed Minnesota Medicaid for services at the time the beneficiary was hospitalized.

As part of the settlement, Intrepid has agreed to strengthen and extend its Corporate Integrity Agreement with the Department of Health and Human Services, the release adds. The settlement will be binding on Intrepid and its subsidiaries, which have reorganized under Chapter 11 bankruptcy.

• HHAs actually get a break and not just a black eye in President Bush's 2007 Medicare budget proposal (see Eli's HCW, Vol. XV, No. 6). The Administration calls for a payment adjustment for "Hip & Knee Replacements in Post Acute Care Settings."

That refers to a MedPAC study that found joint replacement patients avoided rehospitalization and cost the program much less when they received home care versus rehab or nursing facility care (see Eli's HCW, Vol. XIV, No. 16). HHAs could see more lucrative hip and knee replacement patients if lawmakers agree to cut spending for those facilities.

• CMS is pulling back on its Open Door Forum schedule due to budget constraints, the agency says in a notice to providers. CMS now will hold Home Health and DME forums every six weeks instead of every month. The next forum will take place Feb. 28.

• VistaCare Inc. returned to profitability in the quarter ended Dec. 31, 2005. The for-profit hospice chain reported net income of $1.5 million on revenues of $59.7 million, compared to a $0.7 million profit on revenues of $56.6 million for the same period in 2004. Last quarter, VistaCare reported a $5.1 million loss.

VistaCare attributes the increased profitability to reduced exposure to the aggregate Medicare cap and new operations, particularly alternative site and inpatient units. The company is consolidating its four Utah programs into two programs due to lack of profitability.

Also, VistaCare is in the process of regaining recertification for its Indianapolis and Terre Haute, IN locations after the state decertified them (see Eli's HCW, Vol. XIV, No. 38).

• Executives of Bossier City, LA-based home care service provider Community Care Inc. are facing Medicaid fraud charges. Administrator Janette McKenney, former employee and McKenney's husband Ernest Goldston, owner Carol Morgan and Comptroller Cheryl Foster conspired to bill Medicaid fraudulently for services to McKenney's daughter, who is an eligible home care waiver services recipient, says a release from Attorney General Charles C. Foti, Jr.

Community Care billed Medicaid for services provided by Goldston, even though the program notified the agency that services furnished by McKenney or Goldston to their daughter weren't allowable.