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Home Health & Hospice Week

Industry Notes:

New Codes Added To Home Health Bundling

Published on Thu Nov 11, 2004

Wound care therapy codes top additions.

Home health agencies, suppliers and hospitals will have to watch out for some new codes bundled into the home health prospective payment system starting Jan. 1.

HHAs have to pay for the supplies and services out of their PPS payments. Accordingly, suppliers and hospitals will be denied for the supplies and therapy services provided to patients under a home health plan of care, and have to seek payment from the HHA.

The Centers for Medicare & Medicaid Services is deleting three HCPCS codes for male external catheters with different features (A4347, A4324 and A4325) and replacing them with one code for the devices (A4349).

CMS is adding codes for a chest drain valve (A7040), chest tube accessories (A7041), an exhalation port (A7045) and a trach plug (A7527).

CMS is replacing a general wound care code (97601) with two more specific debridement codes (97597 and 97598). And it is adding two codes for wound vacs (97605 and 97606). More details are in CR 3525 dated Oct. 29, to be posted at www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.

  • Payment of medically necessary power wheelchair claims in the Houston, TX area is just about back to normal after the Operation Wheeler Dealer slow-down, a CMS official said in the Nov. 9 Open Door Forum for home care providers. But Seth Johnson of Pride Mobility Corp. reported continuing problems obtaining payment for claims in that area.

    Meanwhile, Erik Sokol with the Power Mobility Coalition voiced a concern with the high number of wheelchair claims being subject to additional development requests (ADRs).

    CMS soon will issue policies on wheelchair coverage, wheelchair coding and power-operated vehicles (scooters), an official noted in the forum.

  • Salaries increased 3.3 percent from 2003 to 2004 for HHA executive directors and CEOs, according to a new salary and benefit survey from Oakland, NJ-based Healthcare Compensation Service. The base median salary was $93,200. "Voluntary" HHAs were at the high end of the scale with a median $129,535 salary for executive directors, while hospital-based HHA directors had the lowest pay with a median $87,500 salary.

    Management salaries increased 3.7 percent and registered nurses' salaries grew 3.9 percent from 2003 to 2004, says the survey conducted in conjunction with the National Association for Home Care & Hospice.

  • Maryland will launch a consumer-directed demonstration plan called "New Directions," CMS says in a release. Under the waiver plan, beneficiaries will "be able to select and direct their personal assistants and use a portion of their individual budget for non-traditional goods and services," CMS explains.

    "Allowing persons with disabilities to engage in 'self-direction' is a high priority for the Bush Admin-istration," CMS Administrator Mark McClellan says in the release. "Self-direction is a proven approach to higher beneficiary satisfaction for the same or lower costs."

  • Suppliers who want to attend the next Program Advisory and Oversight Committee meeting for competitive bidding must register by Dec. 2. This time around, the PAOC will take public comment during the event, CMS says.

    The meeting will take place Dec. 6 and 7 in CMS' Baltimore headquarters. Instructions for registering are at www.cms.hhs.gov/suppliers/dmepos/compbid/paoc.asp#meeting    .

  • CMS has updated HAVEN software with new 2005 diagnosis codes after all. The free OASIS software was giving users error messages when they used codes that took effect Oct. 1 (see Eli's HCW, Vol. XIII, No. 37, p. 295), and CMS originally said it didn't plan an immediate fix.

    Agencies can download the ICD-9 update to HAVEN 6.2 at     www.cms.hhs.gov/oasis/havensof.asp.

  • Invacare Corp's U.S. power wheelchair sales were down 45 percent in the quarter ended Sept. 30, compared to the same quarter in 2003. "The difficulty and uncertainty related to customers obtaining Medicare reimbursement from [CMS] for consumer power wheelchairs caused this decrease in rehab products sales," the Elyria, OH-based company says in its earnings release.

    Invacare's U.S. respiratory product sales were up 56 percent, however. Overall, the company reported net income of $22.5 million on $349.5 million in revenues for the quarter, compared to a $20.0 million profit on $327.4 million in revenues during year-ago quarter.

  • The cuts to respiratory medications have hurt Apria Healthcare Group Inc.'s bottom line. The Lake Forest, CA-based company lost $11.5 million due to the cuts, it says.

    Apria reported net income of $29.8 million on revenues of $346.6 million for the quarter ended Sept. 30, compared to a $28.9 million profit on $346.3 million in revenues for the same period in 2003.

    Apria acquired more providers than usual in 2004, and its related expenses thus were abnormally high, it says. The company also suffered revenue loss when it decided to pull out of its Gentiva CareCentrix contract, it says (see Eli's HCW, Vol. XIII, No. 4, p. 31).

  • California HME suppliers are dropping out of Medicare and Medi-Cal because the reimbursement hassles aren't worth the business. Receiv-ables on Medicare and Medi-Cal equipment reached over a year, so El Dorado Hills-based Specs Healthcare Ability Centers cut its staff from 20 to three and stopped accepting the programs, owner Scott Vogelsang told the Sacramento Business Journal.

    California is a bellwether state, and suppliers across the country may be following suit, the paper predicts. That could lead to access problems for Medicare and Medicaid beneficiaries, especially under competitive bidding.

    Medi-Cal reimbursement rates for DME went down significantly last October, the Journal notes. As a result, subsidized services such as respiratory therapy and wheelchair maintenance, which the state reimburses poorly or not at all, are threatened.

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