Home Health & Hospice Week

Pending Medicare physician cut even bigger than last year's.

News of a pending steep cut to Medicare phy-sician payment rates could actually result in home care payment cuts instead.

The Centers for Medicare & Medicaid Services has announced that docs' conversion factor in 2007 will be 36.1542--4.6 percent lower than this year's rate--unless Congress steps in again. That 4.6 percent cut is even higher than the 4.4 percent cut that threatened physician payments this year.

Chances are lawmakers will bail out physicians again in 2007--and the money may once again come partly from home care payment reductions, industry veterans warn.

The law requires CMS to cut physician payments each year if spending grows faster than the overall economy, and CMS has predicted sharp cuts every year until 2015.

Physician spending increased 8.5 percent in 2005, and almost all of that growth (7.5 percent) came from physician services, not drugs or supplies. The biggest increases came from evaluation & management (2.6 percent), procedures (2.5 percent) and imaging scans (2.3 percent).

• Congressional representatives are now hopping on the bandwagon to defeat the Deficit Reduction Act.

Rep. Henry Waxman (D-CA) is calling on fellow lawmakers to investigate "the White House's knowledge of the constitutional defects" of the DRA, signed into law Feb. 8 by President Bush--a move that could have big implications for DME suppliers.

The version of the DRA signed by President Bush (S. 1932) is not the same as the version passed in the U.S. House of Representatives on Feb. 1. The House version requires Medicare to lease durable medical equipment to beneficiaries for up to 36 months, while the version signed by the President limits such leases to 13 months. For DME suppliers, the shorter lease period could mean a cut in Medicare revenue of $2 billion over five years.

For an overview of Waxman's allegations, go to www.democrats.reform.house.gov/Documents/20060330160732-44562.pdf.

• HHAs served by regional home health intermediary United Government Services should be seeing their claims adjusted for the rate reduction required by the Deficit Reduction Act. UGS began adjusting claims for the "rollback to the 2005 pricer" April 11, it says on its Web site.

Payment increases for the rural add-on will take a little while longer, however. UGS plans to begin adjusting claims for the rural add-ons May 1, it says.

Both types of adjustments will show up as 32I or 33I adjustments on your remittance advice (RA), the RHHI explains. RHHIs have until July 1 to make the adjustments.

• CMS is offering more clarity on how it decides which local coverage determinations (LCDs) will become national policy. The agency has issued two guidance documents that detail steps in the national coverage determination (NCD) process concerning CMS' determinations of whether an item or service is reasonable and necessary.

The guidance explains the factors CMS considers when initiating a Medicare NCD and determining whether to commission an external health technology assessment (HTA) to evaluate a new health care technology, the agency says in a release. More information is at www.cms.hhs.gov/MedicareCoverageGuideDocs/.

• When you apply for a national provider identifier (NPI), you should include your old identification numbers for other payors--not just for Medicare. This will help payors to develop "crosswalks" between your old number and your NPI. If you include a Medicaid number, make sure you list the state name as well, CMS advises in an April 7 email to providers.

• Now's your chance to comment on the burden of OASIS. In the April 14 Federal Register, CMS requests comments on the burden of OASIS data collection and on OASIS electronic reporting. Comments are due within 30 days of the notice. 
 Instructions on submitting comments are in the notice at www.access.gpo.gov/su_docs/fedreg/a060414c.html --scroll down to the first CMS entry.

• CMS shouldn't create a new benefit category to accommodate high tech assistive devices, such as the Independence iBOT 4000 Mobility System.

At least that's the opinion of Elyria, OH-based Invacare Corp. and other major suppliers of power mobility devices. CMS invited stakeholders to comment recently on coverage of the high-tech PMD product from Independence Technology LLC, a subsidiary of Johnson & Johnson based in Endicott, NY.

"We do not believe ... that CMS has the legal authority to create a new benefit category for a particular manufacturer's device, especially when other manufacturers' products in the market provide similar function and performance," Invacare's Cara Bachenheimer says in written comments to CMS.

• Get ready for a surprise if you're accredited by the Joint Commission on Accreditation of Health-care Organizations.

JCAHO is transitioning to unannounced surveys this year. From 2006 through 2008, the unannounced survey will occur in the year in which the accredited organization is due for its next survey, the Oakbrook Terrace, IL-based accreditor says in a release.

JCAHO will continue to conduct one-day random unannounced surveys in an annual 5 percent sample of providers that have not yet undergone full unannounced surveys, it adds in the release.

• A New Jersey HHA owner has been arrested on charges that he defrauded a non-profit charity of more than $150,000 while he served as vice president. Among other allegations, Keith DaCosta improperly entered into leases for the charity, 100 Black Men of New Jersey, to obtain office equipment and rebate checks for himself and for his home care company, No Barriers Home HealthCare Services Inc., U.S. Attorney Christopher J. Christi says in a release.

DaCosta's lawyer, Richard M. Roberts, told the New York Times that his client "made not a dime on any of the allegations the government has put forth, and he intends to prove it."