Home Health & Hospice Week

Hospice-SNF relationships also targeted.

Home care providers could work even more closely with physicians if the HHS Office of Inspector General gets its way.

In its latest compendium of recommendations for improving operations, known as the Orange Book, the OIG tells the Centers for Medicare & Medicaid Services to improve physicians' roles in home care by educating home health agencies and docs about the topic. The OIG also wants CMS to revise the plan of care to relieve the paperwork burden on physicians.

The watchdog agency also urges CMS to improve physicians' relationships with durable medical equipment suppliers. That would include physician education, requiring the physician to treat the patient before ordering DME or supplies, and requiring the physician's name and specialty as well as the patient's diagnosis information on the DME or supply claim.

And the OIG calls for CMS to more closely monitor oxygen equipment claims and to revise and improve suppliers' compliance with Medicare standards.

Finally, the OIG wants CMS to curb inappropriate referrals between hospices and nursing homes. Some current hospice-nursing home contract provisions could allow fraud and abuse, the Orange Book says.

• HHAs serving higher case-mix patients are also seeing higher profit margins, research by Medicare Payment Advisory Commission staff reveals. Agencies with the lowest case mix had a median margin of 12.3 percent in 2002 while HHAs with the highest case mix saw a median margin of 22.8 percent, MedPAC staff said in the Sept. 8 meeting of the influential advisory body to Congress.

MedPAC will present its findings on the relationship between case mix and profit margin in a mandated report to Congress Dec. 8. While there is a relationship between case mix and profitability, there are too many variables involved in profit margin to pin down the exact nature of the relationship, MedPAC concluded.

Commissioners want more research on case mix and prospective payment system accuracy in the future to inform PPS refinements, they said.

• The gap-filling method to set prices for power wheelchair codes could reduce payments to providers by an average of 25 percent. That's the conclusion of a new study conducted by Muse & Associates for the American Association for Homecare.

When using gap filling to price new DME codes, CMS estimates the price for the 1987 Medicare fee schedule, then calculates the current price using actual increases in fee schedule payments.

The study recommends CMS use 1992 as the historic pricing year for all power chairs, because much of today's technology was developed post-1987. Of the power chair products examined, only nine had pre-2000 price information, according to the study.

 • The changeover from carriers and fiscal intermediaries to Medicare Administrative Contractors (MACs) doesn't mean the Program Safe-guard Contractors (PSCs) won't keep looking at your claims. CMS officials told a Sept. 12 town hall meeting for providers that the PSCs will still have a separate mission to work on integrity, audits and medical review. Each MAC will have a single set of local coverage determinations for its area, and the MAC medical directors will work with local providers to set uniform policies.

• Home care providers that like their paper remittance advices won't have to switch to electronic ones after all, regional home health intermediary Palmetto GBA says. Before August, providers who elected to receive electronic RAs also received paper ones, Palmetto says in a posting to its Web site. Now providers have to choose whether they want to receive electronic or paper ones--they can't receive both.

While providers receiving paper RAs will continue to do so, providers that receive electronic RAs and want paper RAs must fill out an ERA Deactivation Form at www.palmettogba.com, Palmetto instructs.

• Amedisys Inc. has struck out in its latest attempt to obtain $7.3 million in accounts receivable from bankrupt financier National Century Financial Enterprises Inc. Amedisys filed suit against JP Morgan Chase Manhattan Bank to obtain the funds held in a JP Morgan Account for an NCFE subsidiary.

Amedisys argued that its suit against JP Morgan didn't have anything to do with NCFE's bankruptcy and it was just trying to recover funds from the bank. But the U.S. Sixth Circuit Court of Appeals didn't buy the argument and said the NCFE bankruptcy automatic stay continued to apply to the funds, according to the Sept. 13 decision.

• MT Ultimate Healthcare Corp. has inked a nursing service contract with Lake Forest, CA-based Apria Healthcare Group Inc. MTUH will supply to Apria nurses qualified to provide home infusion therapy to patients in New York, the Brooklyn, NY-based company says.

• A Houston physician faces a 13-count indictment for $10 million-worth of wheelchair fraud. Linda Morgan, who is not licensed to practice medicine in Texas, allegedly signed pre-printed prescriptions for power wheelchairs brought to her by freelance marketers for about $250 each, according to U.S. Attorney Chuck Rosenberg. Morgan did not evaluate or even see the patients, the indictment charges.

The marketers would sell the prescriptions to DME companies, which billed Medicare and Medicaid for more costly equipment than patients actually received, Rosenberg alleges. If convicted, Morgan faces up to 10 years in prison and a fine of up to $250,000.