Home Health & Hospice Week

Double-check your NPPES information to avoid hold-ups.

As the first month of National Provider Identifiers comes to a close, the new numbers are still giving providers fits.

"We continue to identify providers submitting claims to Cahaba GBA without a valid NPI number," the regional home health intermediary says in a message to providers.

The problem: Providers either haven't applied for their NPI or the data in their National Plan and Provider Enumeration System (NPPES) NPI file does not match that data in their Fiscal Intermediary Shared System (FISS) file, Cahaba explains.

The solution: If you haven't yet applied for your NPI, do so right now. And it's just as important to check your NPPES file to make sure it's accurate, Cahaba urges. "We strongly recommend that all providers, regardless of whether a problem has been identified, access the NPPES site to verify the information submitted is complete and accurate," the intermediary says.

But if it's your referring physician's information that's incorrect, things may get trickier. Right now, claims must have the referring physician's legacy number (UPIN) to process, Cahaba says. That means you can submit a claim with both the NPI and the UPIN, or just the UPIN alone, the RHHI details.

Do this: If you have claims returned to provider (RTP'd) for reason code 19201, make sure they contain an NPI and UPIN and then resubmit them, Cahaba advises.

Intermediary Palmetto GBA says problems its providers were experiencing with NPI edits have been resolved and claims are processing normally. The RHHI had advised providers to quit using NPIs as a temporary work-around, but now providers should include NPIs on all claims, Palmetto directs on its Web site.

Claims RTP'd due to 19201 "are being moved to location SMNNPI and manually RTP'd for correction of the UPIN, NPI, or physician name," Palmetto says. "All claims should be submitted with the appropriate NPI and UPIN."

Look it up: Meanwhile, home health agencies are eagerly awaiting the unveiling of the NPI directory at the end of this month (see Eli's HCW, Vol. XVI, No. 20). "Since home health agencies are required to have the referring physician's NPI on claims, access to this database is imperative," the National Association for Home Care & Hospice notes.

At first, the Centers for Medicare & Medicaid Services will make the directory available as a download and also in a query-only format, NAHC notes. "The downloadable file will be discontinued if, after some time, the query-only file serves providers' needs," the trade group says.

• Federal lawmakers continue to look for ways to fund the State Children's Health Insurance Program, and that leaves home care providers vulnerable. The Senate Finance Committee plans to address SCHIP legislation soon, although full Senate action on the issue isn't expected until July.

Reauthorizing SCHIP is the committee's top priority, Chair Max Baucus (D-MT) told reporters. While Medicare managed care plans have been mentioned as funding sources for the $50 billion or more needed for SCHIP, home care providers are also considered favorite targets. Legislators are also considering using tobacco tax funds.

Take action: Lobby your representatives now to protect home care providers against Medicare payment cuts to pay for both this popular program and a fix to the 10 percent Medicare payment rate cut for physicians, NAHC urges.

• If your test of the practice grouper CMS has provided for the prospective payment system refinements was yielding some strange results, you may want to give it another try.

CMS has corrected problems with the "toy grouper" it issued earlier this month. "The revised version corrects several typos related to determining the Home Health Resource Groups (HHRGs) and case mix weights," CMS explains in an email message.

The revised grouper is available at www.cmshhs.gov/center/hha.asp. "While this tool is not the official grouper software that CMS will add to HAVEN, it is a practice tool that can be used for educational and planning purposes," the agency says.

More grouper-related downloads, such as the grouper logic guidelines and pseudocode, are also on the CMS home health site.

• Look out for audits if you are a durable medical equipment supplier in Medicare's Jurisdic-tions A or B.

On June 11, TriCenturion, the DME program safety contractor (PSC) for Jurisdiction B, announced a widespread compliance probe of group 2 power wheelchairs (HCPCS K0823) for Jurisdictions A and B.

Suppliers whose claims are selected for review will receive an Additional Documentation Request (ADR) letter asking for information to determine if the item billed complies with the existing "reasonable and necessary criteria." Your claim will deny if you fail to supply the requested information within 30 days, cautions TriCenturion.

The full bulletin is at www.tricenturion.com.

• The HHS Office of Inspector General has combined its Red and Orange Books on unimplemented cost-cutting recommendations, but the message of the newly merged document is the same: require physicians to examine beneficiaries before ordering home care services for them.

The OIG's new compendium wants docs to have to examine benes before ordering services because "unallowable services [continue] to be provided because of inadequate physician involvement," it says.

DME cuts: The OIG also lists reducing the oxygen rental period from 36 to 13 months as a "priority recommendation." And it wants law- and policymakers to reduce reimbursement rates for category I enteral nutrition formula, edit durable medical equipment claims for valid and active ordering physician UPINs, and delay DME payments until the end of the service period for the equipment.

The compendium is at www.oig.hhs.gov/publications/docs/compendium/Compendium2007.PDF.

• If you're including taxonomy codes on your HHA or hospice claims, make sure they're the right ones. CMS actually doesn't require HHAs and hospices to submit taxonomy codes on claims, regional home health intermediary Cahaba GBA says. But those providers can choose to use them if they want to.

However, submitting invalid codes will result in claims rejections, even if the codes aren't required, Cahaba cautions. "If your home health or hospice agency chooses to include a taxonomy code on your claims, ensure that the taxonomy code is valid" to avoid payment delays, the intermediary advises.

• HHA mergers and acquisitions in the first quarter of 2007 were down slightly from the previous quarter, but up substantially from the same quarter in 2006, notes The Braff Group. HHA deals numbered 22 during the quarter, down from 24 in the fourth quarter of 2006 and up from 12 in the first quarter of 2006, the Pittsburgh, PA-based M&A firm says.

Hospice deals were up substantially from three in the last quarter to six this quarter, Braff notes. That's up from two hospice acquisitions in the first quarter of 2006. Publicly traded home care chains like Amedisys Inc. are looking to increase their hospice presence, Braff notes in its journal at www.thebraffgroup.com/Articles/articlespdfs/perspectives/Q1200.pdf.

• CMS touted the proposed $92.63 add-on for low utilization payment adjustment (LUPA) ep-isodes in the latest home health Open Door Forum. The flat add-on, which applies only to first and stand-alone LUPA episodes, is "almost equivalent to a skilled visit," an agency official told hundreds of HHA listeners.

• Spartanburg, SC-based Southern Home Medical Equipment Inc. has purchased the Lafayette, LA location of Evangeline Medical and Nursing Supply Inc., which specializes in diabetic footwear.

"This is a tremendous and exciting time for our company," President Greg Tucker says in a release about the acquisition for undisclosed terms. "We look forward to four additional deals in the works."