Home Health & Hospice Week

Ability to view and fix claims is on the fritz after NPI deadline.

Providers hoping for a smooth Medicare claims processing transition, for once, were disappointed May 23.

That's the date that Medicare began requiring providers to submit claims and other HIPAA-compliant transactions with a National Provider Identifier number only--no Medicare legacy numbers, such as OSCAR numbers.

Problem: "Due to the installation of the NPI-only requirement for May 23, 2008, we are experiencing a problem with providers viewing and updating the RTP file and doing adjustments to previously paid claims," reports regional home health intermediary Cahaba GBA in a message to providers.

More problems: RHHI Palmetto GBA is seeing similar disruptions. "Providers are unable to view claims in the Corrections and Summary Menu," Palmetto says on its Web site. Also, "providers are unable to key their PTAN and NPI numbers in Direct Data Entry (DDE) System."

The Centers for Medicare & Medicaid Services' claims system contractor knows of the problems and is working on them, both RHHIs assure.

Solution: For Palmetto's DDE entry problem, providers can use their mouse to get the cursor into the NPI field, the RHHI advises. Then providers should be sure not to enter legacy numbers.

Providers might be experiencing more customer service hassles due to the NPI as well. Thanks to NPI rules, Cahaba must "authenticate certain provider identification elements for telephone inquiries," the intermediary tells providers in a recent message.

Providers must enter their NPIs and legacy numbers for customer service, Cahaba instructs. If one of those is invalid, the provider must provide two of the following: provider name, tax ID number, remittance address or master address.

"Please be prepared to provide this information when you call," Cahaba says.

• Providers will be operating under revised claims appeals rules starting in August. CMS has finalized wide-ranging revisions to appeals in a May 23 Federal Register notice.

Among the changes is a requirement that providers must add any issues to an appeal within 60 days of the original 180-day period for appealing the claim payment.

Multiple commenters argued against this change, CMS notes in the rule. They said it restricts provider appeal rights, denies access to appeals and fails to give providers enough time to identify issues.

But CMS stuck by its guns. "For the efficient administration of the appeals process, we believe our policy of having the appeal resolved as early as possible, while at the same time giving the

parties to the hearing ample opportunity to present their cases, is appropriate," the agency maintains.

• Negotiations are heating up over the bill to halt physician's Medicare payment rate cuts that take effect July 1, and home care providers could end up getting burned. Senate Finance Committee Chair Max Baucus (D-MT) is moving ahead with a Democrat-authored Medicare package after negotiations over a bipartisan bill fell through, according to press reports.

The main point of contention between Republicans and Democrats is whether to pay for the physician payment change by cutting payments to Medicare Advantage plans. The White House opposes MA plan cuts and Republicans are fighting against them.

If lawmakers can't pay for the bill with MA funds, they are likely to turn to rate cuts for providers such as home health agencies, hospices and durable medical equipment suppliers instead, observers fear.

Baucus hopes to get the bill on the Senate floor by early to mid June, he told reporters.

• If the relationship between OASIS items and prospective payment system reimbursement is still a bit foggy, you can gain clarity with a new tool offered by RHHI Cahaba GBA.

While it doesn't specify payment amounts, a new tool from the intermediary identifies which M0 items contribute to which dimensions and nonroutine supply (NRS) payments. "This tool is designed to assist home health providers in understanding which OASIS items relate to and impact the clinical, functional, and service domain scores under the HH PPS refinement," Cahaba says.

The tool is at https://www.cahabagba.com/rhhi/education/materials/quick_homehealth_moitems.pdf or email editor Rebecca Johnson at rebeccaj@eliresearch.com with "M0 Item Tool" in the subject line for a free pdf copy.

• States continue to boost their home care programs. The latest example is Colorado, where Gov. Bill Ritter (D) signed legislation increasing funding for in-home services by $3 million.

"This bill is so important not only because it makes fiscal sense, but also because it is just the right thing to do--keeping seniors in their own homes," state Sen. John Morse (D) says in a release. "It makes the most sense for the seniors, their families and for taxpayers."

• You can get free help in figuring out how to download and print remittance information, contractor National Government Services says. CMS is offering a new brochure with "an overview of free software that enables physicians and suppliers to view and print remittance information," NGS notes.

The brochure is at www.cms.hhs.gov/MLNProducts/downloads/MedicareRemit_0408.pdf.

• The Medicare Payment Advisory Commission has appointed three new commissioners, but once again none of them directly represent home care. The last time MedPAC had a home care-related commissioner was when Carol Raphael, CEO of the Visiting Nurse Service of New York, served from 1999 to 2005.

The new commissioners are Peter Butler, executive vice president and chief operating officer of Rush University Medical Center; Michael Chernew, a professor of health care policy at Harvard Medical School; and George Miller, senior vice president of Catholic Health Partners and president and CEO of Community Mercy Health Partners, according to a release. Reappointed members are Jennie Chin Hansen, a member of the AARP Board of Directors, and Nancy Kane, professor of management at the Harvard School of Public Health.

Former CMS Administrator Nancy-Ann DeParle is departing the commission.

• If you have a bone to pick about DME coverage, you may have to speak to a different contractor. Responsibility for DME local coverage determinations (LCDs) is now in the hands of DME Medicare Administrative Contractors. DME MACs took over the workload from DME Program Safeguard Contractors March 1, CMS says in recent Transmittal No. 253 (CR 5953).

• Investor interest in home care remains piqued. MBF Healthcare Partners and the Goldman Sachs Urban Investment Group have acquired Coral Springs, FL-based OMNI Home Health for an undisclosed amount, the equity groups say in a release.

OMNI has 30 locations in Florida, Pennsylvania, Ohio, Indiana and Illinois, say the companies that will jointly own it. "We have been looking at making an investment in the home nursing industry for quite some time," MBF Chair Miguel Fernandez says in the release.

OMNI aims to become a national provider, adds Goldman Sachs' Martin Chavez.

• Billers are on the hook, too, for government fraud, a recent case shows.

New York authorities have charged Medi-caid home health agency operator Charles Zizi of Always There Homecare with defrauding the program of more than $300,000 by billing services never rendered, inflating nurses' hours and billing for maximum authorized services instead of services actually provided.

Biller Ricardo Francois submitted the false claims to Medicaid and was charged as well, according to a release from New York Attorney General Andrew Cuomo.

"These defendants used a home care agency under their control as a personal criminal enterprise to rip off taxpayers and cover their own extravagant expenses," Cuomo says in the release. Zizi faces a 40-count indictment and Francois faces a nine-count indictment.

New York providers can expect more scrutiny, with other states likely to follow suit. "Attorney General Cuomo has made cleaning up the home health industry a priority of this administration," the release notes.