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Home Health & Hospice Week

Industry Notes:

More Claims Scrutiny On The Way

Published on Fri Jan 28, 2005

Three states see pilot program rewarding new audit contractors for recoupments.

Yet another MMA pilot project will be making home care providers' lives harder starting this year.
 
Home health agencies, hospices, suppliers and other providers in New York, California and Florida will see their claims get another round of scrutiny from "Recovery Audit Contracts," according to a Jan. 10 Medlearn Matters article.
 
As mandated by the Medicare Modernization Act of 2003, Medicare will compensate RACs "through retention of a percentage of the overpayment recoveries," the article says. In other words, the more these new audit contractors recoup from providers, the more money they will make.
 
The Centers for Medicare & Medicaid Services expects the three-year pilot project to begin in May. If the feds like the RAC pilot, it may expand nationwide.
 
RACs will also return to providers any underpayments they find, CMS notes in the article at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0469.pdf. And providers will be able to appeal negative determinations to their usual intermediaries or carriers. 


  • Coming oxygen cuts to Federal Employee Health Benefit Plan levels will be a big burden on the industry, one expert warns. But oxygen suppliers have seen rougher payment cuts before. In the late 1990s, they underwent massive 30 percent cuts at the hands of the Balanced Budget Act.
     
    But this coming 10 to 20 percent cut "is still going to hurt," predicts Harold Davis, respiratory specialist for The VGM Group's Nationwide Respiratory division. Suppliers that are already on tight margins will be likely to pull out of business lines that require pricey overhead, such as liquid oxygen, he expects. "That will cause more patients to be in their homes and tied to tanks," Davis laments.
     
    CMS is waiting on HHS Office of Inspector General data to set the new payment rates. In the meantime, durable medical equipment regional carriers are paying claims at 2004 levels (see Eli's HCW, Vol. XIV, No. 3, p. 19).     

     
  • Home health agencies rose to the challenge of providing care in the recent blizzard that swept the Northeast. One such agency was Visiting Nurse Association of Boston, the VNA says in a release. VNA visiting staff traveled on foot to see high-risk patients, and one VNA nurse teamed up with local police officers who escorted her to seven visits.

  • Connecticut is the newest state to get consumer-directed care. The Department of Health and Human Services has approved a consumer-directed care waiver, which will cover personal care, supported employment, group day services, vehicle modification, transportation, specialized medical equipment, companion services and family training, CMS says.
     
    Participants "will be able to select and direct their personal assistants as well as manage many other services for themselves," CMS says.
     
    The Connecticut Medicaid waiver is the 10th program HHS has approved under the Bush Administration's "Independence Plus" initiative.
     
    "Allowing persons with disabilities to engage in 'self-direction' is a high priority for the Bush Administration and this agency," CMS Administrator Mark McClellan says in a release. "Self-direction is a proven approach to higher beneficiary satisfaction for the same or lower costs."     

     
  • The home health industry is likely to grow more than 10 percent annually for the next five years, predicts Kiplinger Business Forecasts. As part of that growth, hospitals will get back into the HHA business, Kiplinger expects.
     
    The industry's main challenges will be rate cuts or freezes from government payors and staffing shortfalls, Kiplinger says.      

  • Houston, TX has a new home medical equipment supplier. Sartorius Medical Solutions has opened up shop and carries a number of HME items, reports the Houston Business Journal.

     
    Sartorius is part of United Kingdom-based, physician-owned Mild Professional Care that manages and operates hospitals, long-term care facilities and health care centers in the U.K. and the U.S., the paper says. The company will serve other health care providers as well as patients.

  • Looking for more information on CMS' demonstration project that will help Medicare beneficiaries pay for antiviral medicines? The Influenza Treat-ment Demonstration covers FDA-approved drugs for the treatment and targeted prevention of influenza.
     
    Beneficiaries must have symptoms of influenza or have been exposed to diagnosed influenza or to a beneficiary in an institution where there has been an outbreak of influenza, CMS explains. "The demo doesn't cover these antiviral drugs for general prophylactic use," CMS says.
     
    More information is at     www.cms.hhs.gov/researchers/demos/flu or www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM3696.pdf.

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