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Home Health & Hospice Week

Industry Notes:

OIG Plans More Therapy Audits

Published on Mon May 16, 2005

 But audits won't hit every region, OIG says.

Home health agencies should prepare to take more heat on the high-therapy threshold.
 
The HHS Office of Inspector General recently conducted an audit of a Connecticut HHA and downcoded nearly half of the high-therapy claims reviewed (see Eli's HCW, Vol. XIV, No. 21, p. 162). Now the OIG is planning to conduct "a couple" more reviews of HHAs in this matter, an OIG spokesperson tells Eli.
 
When an HHA furnishes 10 or more therapy visits to a patient, it can increase the episodic payment by as much as $2,500. The Connecticut audit scrutinized episodes with 10 to 12 therapy visits provided.
 
The OIG will conduct "several" more reviews on this topic, but will not have one in every one of the agency's nine regions, the spokesperson says. After finishing its reviews, the OIG may roll them up into one report that identifies patterns across the audits.

 

  • Apria Healthcare Group Inc. is considering putting itself on the auction block. The Lakewood, CA-based home medical equipment company has hired Morgan Stanley to contact parties interested in purchasing it. If potential buyers name an attractive price, Apria's board would consider such a transaction.

    "The company is in strong financial condition, has an excellent management team and considers its prospects to be very good," states Chairman David Goldsmith. "Accordingly, no decision has been made to proceed with a sale and the board of directors may conclude that shareholder interests are best served by remaining an independent, publicly owned company."

     

  • The former head of the Centers for Medicare & Medicaid Services' Interagency Wheelchair Working Group has lost his ability to practice medicine for a year and must pay $20,000 for falsifying documents. CMS Chief Clinical Officer Dr. Sean Tunis agreed to the penalties to settle charges that he falsified documents pertaining to the completion of a continuing medical education course, the Washington Post reports.
     
    Tunis must also complete an ethics course and 35 hours of CME, according to the paper. CMS has not said whether Tunis will remain as CCO of Medicare and director of the Office of Clinical Standards and Quality.

     

  • If you're confused about when Medicare covers one-time skilled nursing visits, a new provider education article from regional home health intermediary Cahaba GBA may help. Normally Medicare does not cover one-time SN visits because they don't meet the requirement that the nursing need must be intermittent, the RHHI explains in its June newsletter to providers.
     
    Medicare does cover one-time visits if the HHA establishes a need for intermittent care, but something unforeseen such as a hospitalization or patient death occurs. And Medicare covers single SN visits if the patient is receiving covered skilled therapy visits, Cahaba says.
     
    One-time SN visits to complete OASIS do not qualify for coverage unless the nurse furnishes another medically necessary service during the visit, the RHHI warns. The article is at     www.iamedicare.com/Provider/ newsroom/newslines/0605.pdf.

     

  • Congress is not picking on HME suppliers. That was the message former CMS administrator Tom Scully delivered to the American Association for Homecare's Washington Leadership Conference held earlier this month. The Republican-controlled Congress does not like "price fixing" and for that reason has pushed for competitive acquisition, he said.
     
    Scully currently works as an attorney in Alston & Bird's Washington office.

     

  • The Scooter Store has filed yet another lawsuit against the feds. This time the target of the company's ire is CMS, which TSS says continues to wrongly deny valid claims submitted with physicians' orders. Earlier this year the New Braunfels, TX-based company sued the Department of Health & Human Services over the denial of hundreds of its power wheelchair claims, arguing that suppliers should not have to provide documentation beyond the certificate of medical necessity.
     
    TSS has also filed a motion to dismiss recent counterclaims from the Department of Justice. The DOJ alleges TSS wrongly told people who called the company's toll-free number that Medicare would pay for power wheelchairs but not less expensive scooters.

     

  • Lincare Holdings Inc. experienced a drop in earnings for the first quarter of this year.
     
    The Clearwater, FL-based oxygen and respiratory services provider reported net income of $54.6 million on revenues of $305.2 million for the quarter ended March 31. That compares to earnings of $62.9 million on revenues of $306.9 million for the same period last year.
     
    The company blamed the earnings decrease on Medicare rate cuts for respiratory medications and certain items of DME that took effect on Jan. 1, 2005. The company estimates the changes reduced operating income in the quarter by $43 million.

     

  • Amedisys Inc. is expanding its presence in the Volunteer State. The Baton Rouge, LA-based regional home nursing chain has acquired two Tennes-see HHAs, it says in a release.
     
    Amedisys has bought agencies in Nashville and Murfreesboro from Nashville-based Saint Thomas Health Services for $3 million in cash and a $500,000 note payable over two years. The company expects the HHAs in the certificate of need state to contribute $4.5 million in annual revenues.

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