Home Health & Hospice Week

If you've seen a decrease in your hospital referrals since 2004, a new report might point to the reason why.

A Medicare payment system edit started enforcing the post-acute care transfer policy for hospitals on Jan. 1 of that year, points out a new report from the HHS Office of Inspector General (A-04-07-03035).

Background: Under the transfer policy,hospitals' DRG payments get prorated if they discharge a patient to home care before the median length of stay. The patient must go to home care within three days of discharge to trigger the proration.The Centers for Medicare & Medicaid Services expanded the policy to a whopping 273 DRGs last year (see Eli's HCW, Vol. XVI, No. 28, p. 215).

Medicare overpaid hospitals nearly $25 million for improperly identified claims that should've been subject to transfer policy proration from 2003 to 2005, the OIG says in the report. Some of the overpayments occurred after the new edit should have prevented them.

CMS will collect overpayments for the errors and look into why the system didn't catch the ones it should have, the agency says in response to the report. The report is online at www.oig.hhs.gov/oas/reports/region4/40703035.pdf.

• CMS is going full steam ahead with its requirement for durable medical equipment suppliers to acquire $50,000 surety bonds by May 4 (for new suppliers) or Oct. 2 (for existing suppliers).That includes a March 17 special Open Door Forum on the topic.An audio recording and transcript of the forum will be posted at www.cms.hhs.gov/OpenDoorForums/05_ODF_SpecialODF.asp beginning March 25, CMS says.

• The Obama administration's hold on regulations issued in the waning days of the Bush administration won't affect the timeline for ICD-10 implementation. "The effective date will not be extended and the comment period will not bereopened" for the ICD-10 final rule and the related electronic standards rule, CMS says in a message to providers.

CMS had already delayed the compliance date for ICD-10 from the proposed 2011 to 2013 (see Eli's HCW, Vol. XVIII, No. 4, p. 31). No furtherdelays were necessary, the agency maintains.

The measure will expand the diagnosis code set from the current 17,000 codes under ICD-9 to more than 155,000 codes under ICD-10.

• Eight weeks into Barack Obama's presidency,15 key leadership positions at the Department of Health and Human Services remain open,including the CMS administrator spot. "The department is really starting behind," former HHS Secretary Tommy Thompson told the Kansas City Star.

But those spots shouldn't be open too much longer, predicted Kaiser Family Foundation President and CEO Drew Altman. "The planes are circling the landing strip," he told the newspaper.

Confirmation hearing dates had still not been set at press time for HHS Secretary nominee Kathleen Sebelius. But home care industry representatives continue to voice support for the Democratic Kansas governor.

"As a community that is currently struggling with significant policy changes and deep payment cuts, we welcome their leadership in addressing the issues currently impacting quality home oxygen care and hope to work with them to reform and strengthen the Medicare home oxygen therapy benefit," says the Council for Quality Respiratory Care about Sebelius and White House Office of Health Reform head Nancy Ann DeParle.

• This might be the year to gain more home infusion coverage, hopes a group of bipartisan members of Congress. U.S. Sen. Blanche Lincoln (DArk.) and U.S. Rep. Eliot Engel (D-N.Y), along with numerous cosponsors, are raising the profile of legislation they introduced in January to increase coverage of home infusion-related services, supplies, and equipment.

S. 254 and H.R. 574 would save the Medcare program money by curbing hospital infusion costs, the legislators contend.

• If you missed the Jan. 30 deadline to apply for DME accreditation, you might be out of luck when the Sept. 30 due date rolls around.

Suppliers who submitted applications by the deadline will have their decisions by Sept. 30, CMS promises in an e-mail message to suppliers. "DMEPOS suppliers submitting applications to an accrediting organization, on or after February 1, 2009, mayor may not have their accreditation decision by the September 30, 2009 deadline," the agency warns.

•Wondering how the new RecoveryAudit Contractors plan to review -- and possibly deny -- your claims from afar? Now you have part of the answer. The RAC for 17 states, Las Vegas-based HealthDataInsights Inc., will use Milliman Care Guidelines "content and software" to review Medicare claims, Milliman says in a release. "The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence," the Seattle-based company says.

The company provides guidelines for seven topic areas including home care and chronic care. The Care Guidelines include quality measures and "each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes," Milliman says.

• If you've grown frustrated with different policies from different Medicare contractors for sleep apnea testing, your troubles will soon be over. That's because CMS has changed its tune and decided to establish a national policy that allows payment for these tests when a physician is initially diagnosing obstructive sleep apnea (OSA).

The new National Coverage Decision "may result in more OSA testing by home health agencies since it eliminates limitations on testing in the home that were imposed by some contractors," notes the National Association for Home Care & Hospice. Three of the four covered tests that physicians can use to diagnose sleep apnea can be done in the home,NAHC points out.

"This coverage decision establishes nationally consistent coverage and assures that beneficiaries who have sleep apnea can be appropriately diagnosed and referred for treatment," said CMS Acting Administrator Charlene Frizzera in a statement.

To read the new policy, visit www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=227.

• Pay for performance may not be all it's cracked up to be. So says a study in the latest issue of the journal Health Affairs.

P4P programs adopted for physicians by health plans have failed to translate into "breakthrough quality improvements," say RAND Corp.researchers. P4P has helped speed information technology improvements, however, they add.

• If you're a home health agency in Connecticut, Maine, Massachusetts, New Hampshire,Rhode Island, or Vermont, don't ignore mail from your new Medicare Administrative Contractor.

National Heritage Insurance Corp.,which is taking over as HH MAC from regional home health intermediary National Government Services, has mailed request letters to providers that currently have an electronic funds transfer (EFT) agreement with NGS, it says in an e-mail message to providers. "You are required to submit an updated CMS-588 authorization agreement form for EFT to NHIC," the incoming MAC stresses. "Providers who fail to submit an EFT agreement to NHIC ...may experience possible payment delays and/or disruption in electronic claim payments."

• Regional chain LHC Group Inc. saw earnings increase in the quarter ended Dec. 31.

The Lafayette, La.-based company reported net income of $10.5 million on revenues of $111.5 million for the quarter. That's up from a $2.7 million profit on $81.2 million in revenues for the same period in 2007.