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Home Health & Hospice Week

Industry Notes:

New Year Brings New Bundled Codes

Published on Thu Dec 04, 2003

Trach, wound care codes most affected. 

A plethora of new codes will be added to and deleted from the list of supplies that is bundled into the home health prospective payment system in the new year.

When supplies codes are placed on the bundling list, suppliers can't obtain payment for those items separately while a patient is under a home health plan of care.

Starting in January, 17 codes for wound care dressings will be bundled, mostly for different types of bandages in the A6441 to A6456 range.

The Centers for Medicare & Medicaid Services also will add supplies codes for a Chlor-hexidine containing anticeptic (A4248) and an ostomy vent (A4366), and a therapy code for a specific assistive technology assessment (97755), it says in a newly added list to an Oct. 17 One-Time Notification.

Also in the changes are 17 ostomy-related items switched from K to A codes, nine switched and added codes for tracheostomy supplies, and wound care and saline code changes. Two of the trach codes were added in error, however, and will be rescinded before the bundling takes effect, CMS said in the Dec. 3 Open Door Forum for home health. The full list is at http://cms.hhs.gov/manuals/pm_trans/R8CP.pdf.

  • Outspoken CMS Administrator Tom Scully has announced his departure from the post, effective Dec. 15. Under Scully's nearly three-year term as head of the agency, CMS changed its name from the Health Care Financing Administration, focused on furnishing patient outcome data to the public, fostered agency openness with vehicles such as Open Door Forums, and launched the fraud-fighting campaign against power wheelchair abuse. Scully hasn't officially announced his post-CMS plans, but is widely expected to take a lucrative lobbying position.

  • Self-directed care proponents have another piece of information in their favor, although home care experts continue to worry that systems in which beneficiaries hire personal care workers directly don't include enough safeguards to ensure the patients' well-being and safety.

    Researchers at Princeton, NJ-based Mathe-matica Policy Research Inc. found that Arkansas Medicaid enrollees who directed their own personal care services using a cash allowance were more likely to receive the services, and receive them at the level to which they were entitled. Researchers studied Arkansas' self-directed care program, the "Cash & Counseling" demonstration project.

    And better access to personal care services didn't increase Medicaid budgets, because it kept beneficiaries out of more costly nursing homes, said the study published in the latest issue of Health Affairs. The study is at http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.566v1.pdf.

  • Wayward health care providers are still getting excluded from Medicare at a rapid clip, with 153 ousted in October. Health care providers should make sure they check both potential hires and current employees against the HHS Office of Inspector General's list of excluded providers.

    In the Nov. 28 Federal Register, the watchdog agency published a list of individuals and entities excluded from federal health care programs this October. The listing is at www.access.gpo.gov/su_docs/fedreg/a031128c.html.

  • You should prepare to beef up your infection control practices if you're accredited by the Joint Commission on Accreditation of Healthcare Organizations. JCAHO's newly approved standards "sharpen and raise expectations of organization leadership and of the infection control program itself," the Oakbrook Terrace, IL-based accrediting body says. The new requirements will take effect in January 2005.

  • Two Louisiana home care executives stand accused of Medicare and pension plan fraud, says Louisiana U.S. Attorney David R. Dugas. A federal grand jury indicted Harold Austin and Annette Austin on charges that they pilfered from their home care employees' pension plans and received improper Medicare payments for lawn services to their home and vacations.

    The Austins, who are accused of defrauding Medicare of more than $2 million from 1996 to 1999, headed up Health Care Options home health agencies in a number of Louisiana cities, Dugas says. A trial date has yet to be set.

  • Another PACE provider has been named by CMS, this time in Massachusetts. Lynn-based Elder Service Plan of the North Shore, which arranges services for 375 Medicare and Medicaid beneficiaries, has received CMS approval for its request to become a Program of All-inclusive Care for the Elderly. PACE providers arrange for all of a patient's medical and social services, to keep them from entering a nursing home.

  • Even before the newly passed Medicare bill's controversial managed care provisions take effect, more Medicare beneficiaries may begin opting for managed care coverage - and unwittingly curtailing their access to home care services.

    A new regulation from CMS, published in the Nov. 28 Federal Register, permits Medicare+ Choice organizations to offer a reduction in the Part B premium as an additional benefit under their M+C plans. To reduce - or eliminate - an enrollee's Part B premium, the M+CO must accept a reduction of its monthly capitation payment.

    The reg is designed "to make M+C more attractive to Medicare beneficiaries and increase enrollment in M+C plans," CMS says.

  • Genesis Health Ventures Inc. is spinning off its skilled nursing home and rehabilitation business into a new company called Genesis Health-Care Corp. That will allow Genesis to change its name to NeighborCare Inc. and restrict its business to home medical equipment, infusion, respiratory therapy and pharmaceuticals, the Kennett Square, PA-based company says.

  • Amedisys Inc. will use almost $23 million in private placement financing to fund acquisitions, pay down debt and for other general corporate purposes, the Baton Rouge, LA-based regional home nursing chain says. "We will generally focus our acquisition activity on organizations generating between $2 million and $20 million a year in revenue in our current geographic area of activity," says Amedisys CEO Bill Borne.

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