Home Health & Hospice Week

Does' NPIs to be available on the Internet.

You finally have a date that you can expect a National Provider Identifier directory for referring physicians' NPIs.

The Centers for Medicare & Medicaid Services will issue the NPI information June 28 as drawn from National Plan and Provider Enumeration System (NPPES) data.

"Anyone may request NPIs and other NPPES health care provider data from [the Department of Health and Human Services]," HHS says in a May 30 Federal Register notice. "HHS will make NPPES health care provider data available on the Internet."

HHS won't release sensitive information such as physicians' social security numbers, tax numbers and dates of birth. But other NPPES data will be in the directory. "We believe that making these data available on the Internet is the most efficient and effective means of dissemination," HHS says.

More information is online at www.cms.hhs.gov/NationalProvIdentStand.

Compliance risk: And if you don't have your NPI now that the May 23 deadline has passed, you are courting trouble. "At this point, any covered entity that is noncompliant, and has not implemented a contingency plan, is at risk for enforcement action," CMS warns in a message to providers.

CMS' contingency plan guidance "does not mean that providers have an extra year to get an NPI," CMS cautions. Under CMS' plan, providers should be using their own NPIs but can still use the previous "legacy" billing numbers for referring physicians (see Eli's HCW, Vol. XVI, No. 18).

Try this: "Medicare is now asking that submitters send a small number of claims using only the NPI," CMS instructs providers. "If no claims are rejected, the submitter can gradually increase the volume."

• Congress may be looking to raise budget funds by cutting payments to Medicare managed care plans, but home care providers' Medicare payment rates are still at risk.

House Ways & Means Health Subcommittee Chair Pete Stark (D-CA) said in a May 15 hearing that he's considering across-the-board cuts for Medicare providers (see Eli's HCW, Vol. XVI, No. 19).

But in a May 17 hearing and release about Medicare Advantage private fee for service (PFFS) plans, Stark made clear that Medicare PFFS plans are a good place to start making cuts. Medicare pays these plans on average 119 percent of fee-for-service rates. And plan enrollment is skyrocketing because salespeople tell seniors they get extra benefits for receiving the same services as under regular FFS Medicare.

However, the plans tend to charge higher cost-sharing amounts for services such as home care, Stark noted. "My guess is that this is NOT coincidental," he says in a release. "If you don't want sick people, you charge more for the services that they are looking for."

"PFFS plans appear to provide far better value to their shareholders and their companies' bottom lines than they do to Medicare," Stark said.

That means PFFS plans are "at the top of my list" for payment rate reviews, Stark added.

However, that doesn't leave home health agencies, hospices and durable medical equipment providers off the hook. "As we look to improve and protect Medicare, all provider payments must be reviewed and are subject to change," Stark pointed out.

Congress will be looking for ways to raise up to $50 billion for a State Children's Health Insurance Program (SCHIP) continuance and $20 billion to avoid the 10 percent cut to physicians' Medicare payments slated for Jan. 1, the National Association for Home Care & Hospice points out.

Senate Finance Chair Max Baucus (D-MT) and Stark plan to address the potential provider payment cuts next month, NAHC says. That leaves providers a few weeks to lobby their members of Congress to avoid cuts to their rates.

• If you're having trouble getting private insurance companies to pay up for home care services, the House Committee on Energy and Commerce may lend you a helping hand. The Committee has launched an investigation of unfair and deceptive business practices by companies that underwrite and sell long-term care insurance, including home health insurance.

Energy and Commerce Chair John Dingell (D-MI) wrote to two long-term care insurance carriers, Con-seco Inc. and Penn Treaty American Corp., to request claims handling policies and practices documentation. "An unusually high number of policyholders in need of long-term care in nursing home facilities or at home have complained of improper denials of valid claims," says a committee release.

• Durable medical equipment suppliers and hospices can have another crack at commenting on the general Advance Beneficiary Notice. CMS has opened a second comment period on the ABN (CMS-R-131) that will close June 24, the agency notes. The general ABN and lab ABN will combine in the new form, among other changes, CMS notes.

But until the new form takes effect, be sure to continue using the current form, CMS' Elizabeth Carmody cautioned in the May 23 home health Open Door Forum. Home health agencies use a different home health-specific ABN.

Instructions for commenting are in the May 25 Federal Register notice at www.access.gpo.gov/sudocs/fedreg/a070525c.html  scroll down to the "29322--29323 [07--2578]" entry under CMS notices.

• Alabama is the first state in the nation to add self-directed home care services to its Medicaid plan as a permanent feature. CMS eliminated the waiver requirements for such plan additions (see Eli's HCW, Vol. XVI, No. 13). And the Deficit Reduction Act of 2005 allows for expansion of self-directed care.

"When beneficiaries direct their own care ... there are fewer unnecessary institutional placements, higher levels of beneficiary satisfaction, fewer unmet needs, less worker turnover and an efficient use of community services and supports," HHS Secretary Mike Leavitt says in a release.

States must ensure that participants have the necessary information, counseling, training and assistance to enable them to successfully manage their own care, HHS says. But some home care members argue that allowing unregulated paid caregivers is risky.

• Palmetto GBA has added electromagnetic therapy (G0239) to its local coverage determination (LCD) for home health physical therapy (RHHI LCD 99HH-021-L). The change, along with other minor revisions, were effective May 23, Palmetto says.

• The FBI is hunting two suspects in a $9 million Southern California HHA fraud scheme. Lualhati Colgrove, operator of United Life Home Health in Rancho Palos Verdes, allegedly sent unlicensed nurses to make visits, billed Medicare for medically unnecessary visits and billed for visits never made at all, according to a release from the Federal Bureau of Investiga-tion's Los Angeles field office.

Colgrove and two United Life employees, Albert Ulit and unlicensed nurse Merlinda Soreno, are being prosecuted by the L.A. U.S. Attorney's Office. But the FBI so far can't find the latter two.

United Life paid marketers up to $1,200 per patient to recruit beneficiaries to receive unnecessary services. The marketers would offer beneficiaries cash and free diet supplements, the release says.