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Home Health & Hospice Week

Industry Notes:

New Billing Code To Fix Hospice Benefit Period Problem

Published on Mon Jan 24, 2005

Hospices will want to avoid new code indicating Medicare non-payment.

The Centers for Medicare & Medicaid Services is establishing a new billing code that will show a patient is under a hospice benefit period, but Medicare won't pay.
 
Starting July 1, hospices must use occurrence span code 77 in FL36 of the claim when they have failed to get the physician's hospice recert in on time, explains a Medlearn Matters article issued Feb. 15. The code will allow a beneficiary's hospice periods to run continuously in the Medicare system, even though Medicare won't pay the hospice for the days not covered due to the late physician recert.
 
Following the initial benefit period, subsequent periods of hospice care require a written or oral recertification "no later than two calendar days after the first day of each period," CMS says.
 
The article (MM3686) is at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3686.pdf.

 

  • Medicare is going one step further toward paying home health agencies for services delivered in an adult day care setting. Under a three-year demonstration project passed in the Medicare Modernization Act of 2003, five HHAs will furnish home care services to up to 15,000 beneficiaries in an adult day care setting, according to a Medlearn Matters article issued Feb. 4.
     
    Participating HHAs will bill for the patients by putting "HHDAYC" in the remarks section (FL84) of their usual RAPs and final claims, CMS explains. Agencies then will receive 95 percent of the customary  prospective payment system amount for the patient.
     
    CMS will select the five sites from proposals agencies submit in response to a formal solicitation. The demo is slated to begin in July. More information is at     www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3660.pdf.

  • An important reminder for home medical equipment suppliers: With no date set for when the new, lower 2005 rates for oxygen will take effect, oxygen providers should play it safe and bill weekly, John Gallagher of VGM told a meeting of the North Carolina Association of Medical Equipment Services this month. That's because once CMS calculates the  new fee schedule amounts, providers will be reimbursed at the lower 2005 rates (see Eli's HCW, Vol. XIV, No. 3, p. 19).

  • Gentiva Health Services Inc. has reported net income of $6.9 million on revenues of $225.5 million for the quarter ended Jan. 2, 2005, compared to a $41.8 million profit on $203.9 million in revenues for the quarter ended Dec. 28, 2003. However, that whopping $42 million in earnings was largely due to a one-time tax benefit, Lake Melville, NY-based Gentiva says.
     
    But the home care chain still is predicting 2005 earnings will be lower than analysts' predictions. Gentiva expects per-share earnings for 2005 to range from 72 cents to 80 cents, while analysts are forecasting 83 cents a share, notes CBS MarketWatch.
     
  • For-profit hospice chain Odyssey Health-Care Inc. has reported net income of $8.8 million on revenues of $91.3 million for the quarter ended Dec. 31, 2004, compared to an $8.6 million profit on $78.3 million in revenues for the same period in 2003. The Dallas-based company's average daily census rose 14 percent to 7,710 patients in the quarter, it says.

  • Almost Family Inc. has purchased another Florida HHA for its Caretenders chain. The Louisville, KY-based adult day care and home nursing company has acquired Florida Palliative Home Care in Gainesville for undisclosed terms. The acquisition covers 11 counties in North Florida, Almost Family says in a release. The regional provider continues to seek acquisition candidates "in Florida and elsewhere," it says.

  • A Houston medical equipment supplier has been indicted on 32 counts of fraud and money laundering in connection with a scheme to defraud the government.
     
    Sunny Alfred Imeh's company, Transcon Medical Services Inc., billed Medicare and Medicaid for expensive motorized wheelchairs, hospital beds and mattresses while delivering to beneficiaries less costly equipment or no equipment at all, government investigators allege.
     
    The indictment also charges Imeh with paying marketers to recruit beneficiaries to receive durable medical equipment and at times transporting them to doctors' offices where the doctors were paid a fee to sign a certificate of medical necessity. In some instances, beneficiaries never saw a doctor; in others, doctors did not sign the CMNs, never saw the patients and had their signatures forged.

  • A medical equipment company owner in Miami is facing two counts of conspiracy in connection with an elaborate kickback scheme.
     
    From 1998 to 2004, Alberto Bengochea allegedly established arrangements with about 230 Medicare beneficiaries who agreed to let him use their Medicare numbers to submit fraudulent claims for unnecessary respiratory equipment and medications in return for monthly kickback payments, according to the U.S. Department of Justice. He also allegedly paid physicians to falsely certify the medical necessity of the equipment and meds.
     
    In addition, Bengochea is charged with having paid illegal kickbacks to medical equipment suppliers in return for their referral of patients to his pharmacies.
     
    To date, 21 defendants have been convicted of kickback and Medicare fraud-related charges in connection with the investigation conducted by the U.S. Department of Health and Human Services and the Federal Bureau of Investigation.

  • Forsyth Medical Center in Winston-Salem, NC will turn over its home care program to another hospital-based HHA March 1, reports the Winston-Salem Journal. The hospital is getting rid of its home care unit because of anticipated payment cuts to Medicare rates.
     
    Non-profit, Greensboro-based Advanced Home Care, an agency owned jointly by Moses Cone Memorial Hospital, the High Point Regional Health System, Novant Health and the Haywood Regional Medical Center, will take on the Forsyth agency and its 520 patients, the newspaper says.

  • It is inadequate risk adjustment that home health agencies protest for two home care quality measures endorsed by the National Quality Forum and adopted by CMS for Home Health Compare. An earlier Eli's Home Care Week article suggested the measures on acute care hospitalization and emergent care weren't risk adjusted at all (see Eli's HCW, Vol. XIV, No. 6, p. 42).

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