Home Health & Hospice Week

Hospices shouldn't have to do all the heavy lifting when it comes to compliance for patients in nursing homes.

The HHS Office of Inspector General has issued its new voluntary supplemental compliance program guidance for nursing facilities, and the guidance contains hospice provisions.

For example: It's a kickback if a hospice nurse provides nursing services for non-hospice patients at no charge, the guidance makes clear.

Arrangements between nursing homes and hospices "pose several fraud and abuse risks," the OIG warns. Additional room and board payments, inflated payment rates for contracted hospice services, and referring patients to nursing homes in exchange for receiving their hospice referrals are just some of the kickback dangers the OIG names.

Hot spot: Watch out for reserved bed agreements with nursing homes, the OIG adds. They could be a kickback risk depending on how they are arranged. Under reserved bed agreements, nursing homes keep beds open for hospice patients in exchange for payment.

The guidance is in the Sept. 30 Federal Register and posted at http://oig.hhs.gov/fraud/docs/complianceguidance/nhg_fr.pdf.

• States could have to fund more home care if a federal lawsuit filed in Florida is successful. Medicaid beneficiaries have filed a suit alleging that the state forces them to reside in nursing homes when they really want home care. The plaintiffs are seeking class-action status on behalf of about 8,500 Floridians, according to the Associated Press.

Nursing home lobbyists pressured the state government to make qualifying for home care more difficult, the suit charges. "There are very, very, very few people who cannot be cared for outside in the community," Philadelphia attorney Stephen Gold, who is representing the group, told AP. "Why should the state give a damn whether you put the money in the left pocket of the nursing home or the right pocket of the community?"

The 1999 Olmstead Supreme Court decision hasn't provided enough motivation for states to place beneficiaries in home care when appropriate, critics charge. "There's a lot of concern that the nursing home industry is very powerful in many states and has made sure that a lot of Medicaid dollars go to institutional care as opposed to home and community-based care," Toby Edelman, an attorney at the Center for Medicare Advocacy, told AP.

The state says the plaintiffs are trying to second-guess the Medicaid program's decisions.

• While non-suppliers like physicians and therapists furnishing durable medical equipment won't have to submit to the upcoming Medicare-mandated DME accreditation process, some of them will have some new rules.

Next year CMS plans to issue "quality standards designed specifically for anyone furnishing or providing orthotics and prosthetics in order to be reimbursed for such supplies and services under Med-icare Part B," CMS says in a message to providers.

• Another PPS Grouper is available, thanks to the diagnosis coding changes that took effect Oct. 1. The Version 2.03 package "includes the updated GROUPER.DLL software module, an updated version of the grouper logic (pseudocode) and associated tables, and updated test cases to be used by those who are developing their own software to implement the grouper logic," CMS says.

In addition to the new and dropped codes, "CMS has made a large number of changes in the use of other existing ICD-9-CM codes scoring cases," the National Association for Home Care & Hospice points out. "These changes are mainly in the recognition of specific codes in the 078 category as allowable etiologies for specific secondary-only manifestation case-mix diagnoses."

The package is at http://www.cms.hhs.gov/HomeHealthPPS/05_CaseMixGrouperSoftware.asp.

• Part B monthly premiums for Medicare beneficiaries will remain at the same level for 2009, CMS says. The rate will remain at $96.40 due to a bookkeeping methodology that allows a "substantial reduction in the premium 'margin' needed to maintain an adequate contingency reserve in the Part B trust fund account," CMS explains.

About 5 percent of Part B enrollees will have to pay higher premiums based on income thresholds starting this year, however.

The Part A deductible will rise $44 from current levels to $1,068, CMS adds.

• You can get an official overview of the new ICD-10 diagnosis coding system from CMS in a series of free national provider calls. The presentations will highlight differences between ICD-9 and ICD-10 and considerations for updating systems in light of the new codes.

Presenters will include representatives from CMS, the Centers for Disease Control and Pre-vention, the American Health Information Man-agement Association, and the American Hospital Association. The home care-relevant call is Nov. 12. Information about the call, including dial-in information and slides, is at http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.

• If you're looking for Parkinson's information to give to your patients, you can check out a new resource from the National Institutes of Health. The NIHSeniorHealth Web site, which has added a page on Parkinson's, "is geared toward older adults and features clear language," the NIH says in a release.

"The new Parkinson's information on NIH-SeniorHealth is an excellent resource for older adults who want to learn more about the disease and the current treatment options," says Dr. Walter Koroshetz, deputy director of the National Insti-tute of Neurological Disorders and Stroke.

NIHSeniorHealth is a "senior-friendly Web site [that] features research-based, easily accessible information," the NIH adds. Topics include ways to exercise properly, safe use of medicines, and management of diseases such as stroke, diabetes, osteoporosis, and Alzheimer's disease.

The site is at http://www.nihseniorhealth.gov/parkinsonsdisease/toc.html.

• Providers accredited by the Joint Com-mission have a new area to focus on -- medical er-rors due to anticoagulant medications. The Oak-brook Terrace, IL-based accrediting body takes aim at the problem in its latest Sentinel Event Alert.

"Performance error (e.g., administration) is the most common cause of adverse events relating to anticoagulant medications," warns the Commission formerly known as JCAHO.

The Commission furnished a list of 15 suggested actions for anticoagulants and heparin in particular. They include establishing dose limits and eliminating heparin flushes of peripheral IV lines.

The Alert is at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_41.htm.

• Home nursing chain LHC Group continues its string of acquisitions and has cracked a new state market.

Lafayette, LA-based LHC has entered into a joint venture with Cape Fear Valley Health System in Fayetteville, NC, to provide home nursing and hospice services, the company says. The agency will operate under the name of Cape Fear Valley Home-Care and Hospice.

The deal marks LHC's first entry in the North Carolina market, which requires a Certificate of Need (CON). LHC now operates in 14 states, it says in a release.

LHC also has entered into a joint venture with Beauregard Memorial Hospital in DeRidder, LA, to provide home nursing, the chain says. The agency will operate under the name of Beauregard Memorial Hospital Home Health Agency.

And LHC has purchased a provider license to expand home health services into Proctorville, OH, and the surrounding areas, the company adds. This agency will be part of the company's joint venture with St. Mary's Medical Center located across the Ohio River in Huntington, WV.

"In the first nine months of 2008, LHC Group has added 33 locations in nine states through acquisitions," the company says.

• A Nashville-based hospice company with private equity financing has grown to almost 50 locations in two years. Cloverleaf Partners has purchased nine hospices in Texas, Florida, South Carolina, Pennsylvania, Michigan, and New Mexico from Maryland-based Fundamental Long Term Care, reports the Nashville Post. All but one of the acquired locations is in new markets.

"Cloverleaf, which was started in 2006 with backing from Chicago private equity giant Thoma Cressey, now boasts some 48 locations in 16 states," the Post says.

• Effective Oct. 1, you'll have a host of lab codes that you'll be able to report as "CLIA-waived," thanks to a Sept. 12 CMS transmittal on the matter. According to Transmittal 1594 (CR 6179), CMS will now consider 21 additional tests CLIA-waived. You'll have to append modifier QW (CLIA-waived test) to these codes.

To read the list of newly-approved CLIA-waived tests, go to http://www.cms.hhs.gov/transmittals/downloads/R1594CP.pdf.