Home Health & Hospice Week

Heads up: CMS will shut down UPIN registry this fall.

If your cash flow has slowed to a trickle thanks to National Provider Identifier claims hold-ups, you're in good company.

"Since the editing for NPI was implemented, we have had a large volume of claims from numerous providers that have failed, causing the claims to RTP," reports regional home health intermediary Cahaba GBA in an email message to providers.

If any NPIs submitted on the claims don't match the ones listed for that provider in the National Plan and Provider Enumeration System (NPPES), the claims return to provider with reason code 32103 (The NPI number on the claim is not present in the crosswalk file), RHHI Palmetto GBA explains on its Web site.

What to do: Home care providers that see claims with that reason code should verify that all of their NPPES data is correct, Cahaba instructs. Make sure you entered your new NPI on the claim correctly, confirm that your NPI and legacy (OSCAR) number are listed correctly in NPPES, and ensure that the following items match between NPPES and the intermediary's provider file: employer ID number, tax ID number, provider name and provider address and zip code.

Hidden trap: Even something as small as using a "St." abbreviation in one file and "Street" in the other can trigger the RTP, Cahaba warns.

Problem: Of course, checking those items is difficult if the RTP is for the referring physician's NPI.

Solution: As a temporary work-around, Palmetto advises removing the doc's NPI and using her legacy UPIN instead to resubmit. Medicare will continue to accept non-billing-provider's legacy numbers until May 2008.

Another snag: But when providers serviced by Palmetto attempted to do so, they received an RTP with error code 19201 (physician's UPIN and name must be on the claim). Palmetto has reported the problem, the RHHI says on its Web site.

Don't be surprised if you get a call from your contractor. "We are now contacting those providers with large volumes of claims in RTP for reason code 32103," Cahaba says. "When we call, you are encouraged to access your information in NPPES so that your NPPES information can be compared to what we have on your provider file."

Say goodbye: Meanwhile, you'd better hope your referring physicians get up to speed on NPIs quickly. The Centers for Medicare & Medicaid Services will stop assigning UPINs to physicians on June 29 and will shut down the UPIN registry this fall.

CMS' NPI contingency plan, which allows providers to use referring docs' UPINs until May 2008, "will not affect our plans to ... disable the CMS UPIN Registry and its 'look up' functionality on September 30, 2007" CMS warns in May 31 Transmittal No. 207 (CR 5584).

Resource: CMS will host a roundtable conference call about its new NPI directory on June 14. More information is at www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp.

• The Medicare Payment Advisory Commission is currently working to identify "all necessary core items for a discharge assessment tool for all Medicare beneficiaries across all post acute care (Pen-PAC) settings," CMS told the Office of Management and Budget in a May 4 submission (CMS-R-245).

As part of its request for an extension on the Aug. 31 expiration date of the OASIS data set and to make PPS refinement-related OASIS changes, CMS addressed still-pending OASIS recommendations from the OBQI Change and Evolution Program (OCEP).

Items assessing activities of daily living and instrumental ADLs identified by OCEP "will most likely be included in the new PenPAC tool," CMS told the OMB. CMS has begun working with MedPAC to produce the PenPAC instrument, in which providers will see the recommendations set forth by OCEP, CMS says.

• If you're searching for ways to recruit and retain workers, look no further than your benefits package. Employees consider health insurance to be the most important benefit made available by their employers, according to a survey by the National Business Group on Health.

The nationwide survey also found that Amer-ican workers would not reduce their benefits to increase others like a 401(K) plan and had no desire to purchase health insurance on their own instead of going through an employer.

About 75 percent of respondents believed their health plan to be their most important benefit, compared to only 14 percent of respondents who saw their retirement plans as the most important benefit.

• A new Senate bill is buoying hopes for legislative refinements to Medicare's durable medical equipment competitive bidding program. On May 17, Sens. Kent Conrad (D-ND) and Orrin Hatch (R-UT) introduced a companion bill to the closely watched "Hobson-Tanner bill" (H.R. 1845).

The new bill, the Medicare Durable Medical Equipment Access Act of 2007 (S. 1428), could make Medicare's new DME competitive bidding less of a threat to suppliers. Both the Senate and House bills, for example, aim to increase protections for small suppliers, exempt small metropolitan areas and add appeals rights.

• A new bill asks lawmakers to rescind changes to Medicare reimbursement for oxygen equipment. On May 24, Sens. Pat Roberts (R-KS) and Jack Reed (D-RI) introduced a bill that would do away with the 36-month cap on Medicare oxygen payments. The bill would also eliminate the transfer of equipment ownership to the patient.

The bill and a House companion bill both aim to restore the Medicare policy for oxygen therapy to its policy before the Deficit Reduction Act.

• A new federal bill would provide $4 billion in grants to help health care providers pay for information technology. Sens. Debbie Stabenow (D-MI) and Olympia Snowe (R-ME) introduced the Health Infor-mation Technology Act of 2007, which targets 20 percent of its money to rural areas.

• Regional chain LHC Group Inc. is entering into another partnership with a hospital to co-own and operate the hospital's home health agency. LHC will buy controlling interest in Fairhope, AL-based Thomas Home Health Agency from Thomas Hospital. LHC will begin operating the agency, which will retain its name, June 1, the Lafayette, LA-based company says in a release. Thomas HHA has annual revenues of about $710,000.

• Amedisys Inc. continues to expand its presence outside of its initial service area with three new buys.
 
The Baton Rouge, LA-based regional chain has acquired an Oak Park, IL HHA from Patient Care Inc. With a population of almost one million who are 65 or older, the Chicago area is the fourth-largest elderly market in the nation, Amedisys notes in a release. "We now have seven locations in this attractive demographic marketplace," Amedisys CEO William Borne says.

Amedisys also entered the Pennsylvania market by buying a Lancaster agency from Lancaster Regional Medical Center. Amedisys now does business in twenty-two states.

And the company bought a Maryland HHA from Interim Healthcare of Baltimore Inc., according to the release. Maryland is a certificate of need (CON) state, Amedisys points out in the release.

Amedisys expects the Chicago agency to contribute $10 million in annual revenues, the Pennsylvania agency to add $3 million in annual revenues and the Baltimore agency to generate less than $10 million in revenue. The company made the acquisitions for undisclosed terms.

"We are excited about our continued expansion from our traditional southeastern base of operations," Borne says in the release.

Stock analysts applauded the additions. "Overall, these were good acquisitions," judged investment banking firm Stifel Nicolaus.

• It looks as though National Home Health Care Corp. won't be sold to Premier Home Health Services after all.

Background: Shareholders brought suit against NHHC when it rejected an offer from Premier and accepted an inferior one from Angelo Gordon & Co. Investors earlier this year protested in a series of letters to the Securities & Exchange Commission that the Angelo Gordon sale was corrupt and benefited NHHC's management team personally, among other problems (see Eli's HCW, Vol. XVI, No. 9).

NHHC said it would probably accept Premier's superior offer, but now Angelo Gordon has sweetened its buyout offer, upping its price to $12.75 per share and an additional 10 cents per share for shareholders except NHHC officers, directors and their families. The deal also won't include a previously proposed consulting position with the company for Chairman Frederick Fialkow and will lower proposed compensation to CEO Steven Fialkow and CFO Robert Heller, NHHC says in a release. NHHC intends the new terms to settle the class action lawsuit.