Home Health & Hospice Week

Rise in doc visits also brings more scrutiny.

Some of your patients may begin receiving more care at home from an unexpected quarter--physicians.

Physician house calls to Medicare beneficiaries increased 40 percent from 1998 to 2004, according to a research letter published in the Nov. 16 Journal of the American Medical Association. That increase is due in part to the 1998 Medicare increase of nearly 50 percent in reimbursement rates for home visits, the letter maintains. The 2004 allowed charge for a comprehensive visit to an established patient was about $110.

Like home health agency care, physician home care prevents expensive emergency room visits and rehospitalizations and allows hospitals to discharge patients sooner, Eric DeJonge, a Washington, D.C.-based physician who works with Washington Hospital Center's Medical House Call Program, recently told National Public Radio.

Medicare is currently conducting a three-year pilot program under which 15,000 Medicare beneficiaries in Texas, California and Florida will have access to in-home care from physicians. The test aims to gauge whether house calls increase cost savings and improve beneficiary health, NPR noted.

Red flag: But the spike in house calls may also be drawing the wrong kind of scrutiny. The feds are investigating Visiting Physicians Association, a Farmington Hills, MI-based company that sends doctors to the homes of more than 25,000 elderly and disabled patients in Michigan, Ohio, Texas, Georgia and Wisconsin, according to Crain's Detroit Business newspaper.

In court filings, the U.S. Attorney's Office and the HHS Office of Inspector General say they are accusing the company of allegations similar to those filed in a 2000 whistleblower lawsuit, the newspaper says. The suit alleged that Visiting Physicians billed the government for medically unnecessary services and manipulated coding to inflate reimbursement.

Visiting Physicians told the paper it is cooperating with investigators and believes it has done nothing wrong.

• If you know physicians who've faced rejections of claims with G codes for the new power mobility initiative, tell them to double-check where they've been sending those claims.

The interim final rule on power mobility established a G code--G0372--so physicians could bill the Centers for Medicare & Medicaid Services for the additional cost of reviewing required documentation and getting it to durable medical equipment suppliers. The new code was effective for dates of service on or after Oct. 25, 2005.

But some suppliers report that physicians are getting their G codes rejected, according to the Dec. 15 Home Health, Hospice and Durable Medical Equipment open door forum.

As it turns out, the physicians who got rejections were probably submitting the code to the DME regional carrier--not the local Part B carrier as required.

"It was my understanding that the G code would be billed to the local carrier, not to the DMERC," John Warren of CMS said in the forum. "If that code goes to the DMERC, it will be rejected, because the DMERCs can't process those claims."

In addition, the new G code is payable only if all of the information necessary to document the power mobility device prescription is included in the medical record after a face-to-face examination of the beneficiary and if the prescription is received by the PMD supplier within 30 days after the exam.

More G code details are in a Medlearn Matters Article at www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM4121.pdf.

• You might need to check your hospice wage index one more time.

CMS has published another correction to the new Core-Based Statistical Area-based index. CMS published the final wage index in the Aug. 4 Federal Register, then published a correction in the Sept. 30 issue and yet another in the Dec. 23 issue.

The correction, which changes CBSA codes and wage index values among other revisions, is available at www.access.gpo.gov/su_docs/fedreg/a051223c.html (scroll down to the Centers for Medicare & Medicaid Services entries).

• Regional home health intermediary Palmetto GBA has revised its Local Coverage Determinations (LCDs) for home health occupational therapy, physical therapy and speech language pathology. The revisions, including changes to CPT and HCPCS codes, took effect Jan. 1. The LCDs are available at www.cms.hhs.gov/mcd/search.asp.

• The budget reconciliation package pending in Congress also has provisions regarding the outpatient therapy caps.

The compromise bill provides for an interim cap solution that allows patients to apply for medically necessary care beyond the $1,740 cap level, reports the American Occupational Therapy Association.

But the solution is limited to only one year and does not address the issue of linking physical therapy and speech-language pathology services under one cap, AOTA protests.

"We are ... concerned about the new exceptions process outlined in the legislation and its potential burden on Medicare beneficiaries," says Ben F. Massey Jr., president of the American Physical Therapy Association, in a release.

The caps don't apply to therapy furnished under the home health benefit.

• VITAS Innovative Hospice Care is now serving five Missouri counties out of its newly certified Kansas City location. The 39th program VITAS has opened plans to apply for a license to serve the Kansas side of the metropolitan area as well, the Miami-based company says in a release.

• Gentiva Health Services Inc. will lay off about 75 workers in Connecticut, thanks to the scaling back of its contract with managed care payor CIGNA HealthCare. The company expects the exclusion of respiratory therapy and certain durable medical equipment services from Gentiva's CIGNA contract to cost it $40 million in revenues in 2005 (see Eli's HCW, Vol. XIV, No. 40).

Melville, NY-based Gentiva is cutting administrative and claims processing jobs in East Hartford, but the lay-offs will not affect visiting nurses and therapists in the state, reports the Hartford Courant.

• LHC Group Inc. is continuing its strategy of partnering with community hospitals to gain market share in Certificate of Need (CON) states. LHC has agreed to buy a 67 percent stake in Infirmary Home Health, a subsidiary of Infirmary Health Systems based in Mobile, AL, according to an LHC release.

The transaction will allow LHC to serve patients in eight Alabama counties, the Lafayette, LA-based regional chain says. With two home health agencies and an infusion business, Infirmary maintains a census of about 300 patients with 70 employees and expects to report revenues of $8 million in 2005.

LHC has secured five of its seven Alabama locations through partnerships with community hospitals. The company has 30 such partnerships throughout the southeastern U.S., CEO Keith Myers says.

• A long-time provider of home care financing has been sold. Presidential Financial Corp. based in Atlanta, GA has acquired Alamo Capital Corp. based in San Antonio, TX, according to a release.

Presidential will operate Alamo as a subsidiary as it expands the business, the company says.