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Home Health & Hospice Week

Industry Notes:

Oxygen Rates Up In The Air Until After Due Date

Published on Wed Dec 22, 2004

Cuts to oxygen rates likely lower than anticipated.

The feds can't seem to make up their mind about oxygen payment rates, and that means no one will get paid starting Jan. 1.
 
Durable medical equipment regional carriers will hold Medicare claims for oxygen, oxygen equipment and portable oxygen equipment furnished on or after Jan.1, 2005, the Centers for Medicare & Medicaid Services says in a notice. "To ensure Medicare's payments are accurate, these claims will be held until the 2005 fee schedule amounts can be computed based on information CMS expects to receive from the [HHS Office of Inspector General] by January 15, 2005," CMS explains.
 
But it's probably a good sign that the OIG can't settle on a payment rate. "We believe OIG has conceded its original analysis was flawed because it failed to properly compare [Federal Employee Health Benefit Plans'] unbundled payment for oxygen equipment, supplies and contents with Medicare's single bundled equipment price, as industry groups have claimed," notes investment firm Legg Mason in a briefing.
 
"This is likely to result in a 2005 Medicare oxygen equipment cut closer to 5 percent than to 10 percent," Legg Mason says.
 
"We are very gratified that CMS and the [OIG] are willing to refine their analysis of oxygen pricing," Kay Cox, President and CEO of the American Association for Homecare, says in a release.
 
More information is at www.cms.hhs.gov/suppliers/dmepos/. HCPCS codes affected include E0424, E0439, E1390, E1391, E0431 and E0434, AAH notes. 

  • It's that time of year again - time to voice your ideas on anti-kickback safe harbors and new special fraud alerts. The OIG annually solicits proposals for developing new and modifying existing kickback-related provisions.
     
    The OIG will consider a number of factors in reviewing proposals, including the impact on: access to health care services; quality of services; patient freedom of choice and competition among health care providers; the cost to federal health care programs; potential over-utilization of the health care services; and the ability to provide services in medically underserved areas.
     
    Comments must be received by Feb. 8, 2005. The notice in the Dec. 10 Federal Register is at www.access.gpo.gov/su_docs/fedreg/a041210c.html.     
     
  • The marching orders for the new inhalation drug dispensing fee have gone out. Starting Jan. 1, suppliers may bill G0371 for a 30-day fee of $57 or G0374 for a 90-day fee of $80, according to Dec. 10 Change Request 3620.
     
    The fee covers "all inhalation drugs furnished through DME dispensed during a [30 or] 90 day period regardless of the number of shipments or drugs dispensed," CMS says in the transmittal.     
     
  • Hospices in four states served by Palmetto GBA will be under the microscope for continuous home care hours. A new initiative from the regional home health intermediary will focus on utilization of that level of care in Florida, Illinois, Mississippi and Texas, Pal-metto says in a question and answer set from its Nov. 15 hospice meeting.
     
    Palmetto will continue edits on non-cancer length of stay, the RHHI added.     
     
  • The tables may soon be turned on your Medicare contractor. A new survey initiative will collect data on "provider satisfaction with and perceptions about the services provided by Medicare [fee for service] claims processing fiscal intermediaries (FIs) and carriers," CMS says.
     
    A pilot survey will go to about 7,400 providers starting next month. The survey will give providers the opportunity to rate their contractor on seven administrative functions: provider communications, provider inquiries, claims processing, appeals, provider enrollment, medical review and provider reimbursement.
     
    More information on the initiative, termed the Medicare Contractor Provider Satisfaction Survey, is at     www.cms.hhs.gov/providers/mcpss/default.asp.

  • Kansas City Home Care has acquired the clients and employees of Parkville, MO-based Reflections Adult Care for undisclosed terms, reports the Kansas City Business Journal. KC Home Care served seven counties in Missouri and Kansas before the deal closed; with the acquisition it took on three more counties and a live-in services business line, the paper says.

  • VITAS Healthcare Corp. has acquired the assets of Premier Hospice and Palliative Care in Phoenix, the Cincinnati-based company says. The deal, which marks VITAS' entrance to the Phoenix market, should add 220 patients to the hospice chain's rolls. 

     
  • Meadowbrook, PA-based Holy Redeemer Health System has become the largest non-profit provider of home care services in New Jersey. Holy Redeemer's acquisition of the South Jersey-based Visiting Nurse Service System Inc. will put the provider at about 700,000 visits per year in New Jersey and Pennsylvania, reports the Philadelphia Business Journal.

     
    In 2002, Holy Redeemer signed a three-year management agreement with VNSS that gave Holy Redeemer oversight for the agency's daily operations, the newspaper says. That agreement included an option for Holy Redeemer to buy VNSS.

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