Home Health & Hospice Week

Check out the reasons your enrollment application could come back to you.

It's official: If you enrolled in Medicare before the Centers for Medicare & Medicaid Services started using the Provider Enrollment, Chain and Ownership System (PECOS) in 2002, then you can't simply make changes to your enrollment information.

If you do, your intermediary or carrier will send your 855 enrollment form back to you and request a whole new application, according to Transmittal 173 (CR 5338).

Your contractor also will return the application if it lacks a signature, if you sent it more than 30 days prior to the effective date, or if you sent in a new application while you were still entitled to appeal the denial of a previous application, CMS says.

• Invacare, the Elyria, OH-based home medical equipment supplier, hit rough waters last week. The U.S. Department of Justice has subpoenaed Invacare for documents related to "three long-standing and well-known promotional and rebate programs" the manufacturer offers to HME providers, according to a company press release.

Invacare "believes the programs described in the subpoena are in compliance with all applicable laws," it says in the release.

The company reports that it is cooperating fully with the government inquiry, which is being conducted out of Washington, D.C.

And the firm got below-par corporate credit ratings from Standard & Poor's Ratings Services. The newly bestowed B rating means that Invacare can meet its financial commitments but is vulnerable to business or economic downturns, reports The Plain Dealer, a daily newspaper in Cleveland.

Invacare executives plan to refinance $600 million in debt, the paper also reported.

• The pesky zip code edit won't be holding up your claims again for a while. CMS instructed intermediaries to turn off reason code 32114 due to an editing problem, intermediaries report.

The edit was supposed to require a zip code for claims with dates of service after Jan. 1 (see Eli's HCW, Vol. XVI, No. 2). But the edit accidentally also applied to dates of service before then.

"All claims currently pending in status/location SMNEWR with reason code 32114 will be released for processing," regional home health intermediary Associated Hospital Service says in a message to providers.

After the edit is corrected to apply only to claims with service dates after Jan. 1, it will be turned back on, RHHI Palmetto GBA says on its Web site.

Do this: As part of the National Provider Identifier requirements, providers will have to include their zip codes on all Medicare claims.

• New RHHI National Government Services (formerly United Government Services and Associated Hospital Service) issued demand letters for M0175 on Jan. 17 and 18, it says in a posting on its Web site. More information on how to handle the letters--which detail 2001 overpayments for incorrect answers to the OASIS item on prior inpatient stays--including appeals contacts, is at www.ugsmedicare.com/providers/hot_topics/documents/2007/MO175.pdf.

• Palmetto's hold on home health claims while it "verified" 2007 rates is over. "Claims were held to verify the results of the January Fiscal Intermediary Standard System (FISS) update," Palmetto tells Eli. "Once the results were verified, claims were released for processing beginning Friday, January 12, 2007. This is a standard procedure when quarterly system updates are installed."

But the hold caught one Florida agency by surprise. "We have payroll coming on Friday" and no claims processed yet, the provider said Jan. 10.

"This brief hold would not have delayed provider payment as Medicare contractors have 30 days from date of receipt to pay clean (no errors) claims," points out a Palmetto spokesperson.

• Know your rights: Medicare contractors have 60 days to make a decision about your claim during medical review.

After that time, they must either send you a notification of their decision or enter the decision and reason codes into one of the shared computer systems, according to CMS Transmittal 179 (CR 5252).

• If Cahaba GBA is your intermediary, you'd better get your claims right the first time or face payment delays.

Starting Feb. 1, RHHI Cahaba "will no longer return suspended claims for correction to a provider's Return to Provider (RTP) file at the provider's request," the intermediary says in a message to providers. "Therefore, providers are encouraged to make sure the information on their claims is complete and appropriate according to Medicare regulations, prior to submitting them."

• More than 3,000 HHAs have signed up for the National Home Health Quality Improvement Campaign, reports the National Association for Home Care & Hospice.

CMS and the state Quality Improvement Organizations launched the initiative Jan. 12 (see Eli's HCW, Vol. XVI, No. 2). More information is at www.homehealthquality.org.

• Looking for a refresher on the care plan's role in home care? Palmetto has released on its Web site "Plan of Care 101," an educational article targeting home health agencies.

Key questions answered include what the POC must include and who's allowed to sign the document. The article also elaborates on what constitutes a "valid physician signature."

Tip: Don't let a nurse practitioner or physician assistant sign the plan of care in lieu of a physician, Palmetto reminds providers.