Home Health & Hospice Week

Negotiations go down to the wire.

An elimination of the cut to physicians' Medicare payment rates has made a comeback, and it could be bad news for home care providers.

At press time, the Republican-controlled outgoing Congress was negotiating to eliminate the 5.1 percent physician payment cut. That's after congressional observers had declared the fix all but dead in the lame duck congressional session (see Eli's HCW, Vol. XV, No. 41, p. 327).

Lawmakers were eyeing both home health agency and durable medical equipment funding as ways to pay for the physician payment fix, the American Association for Homecare warned in an emergency message to members. AAH and the National Association for Home Care & Hospice urged providers to contact their congressional representatives to retain home care providers' payment rates for 2007.

However, the Senate version of the bill also could have included payment increases for rural HHAs.

• U.S. District Court in Michigan has dismissed a lawsuit seeking to overturn the Deficit Reduction Act of 2005. The suit, Conyers v. Bush filed by Democrats, rested on the fact that the House and Senate failed to approve identical versions of the bill. The Senate version stipulated that Medicare could pay to rent some items of medical equipment for 13 months, while the House passed a version that erroneously stated "36 months" for the capped rental period.

The plaintiffs lack standing to bring the action, the Court ruled. And because House Speaker Dennis Hastert (R-IL) signed the bill, it is valid as law, the Court added.

• In 2005, Medicare Advantage plan beneficiaries cost the federal government $5.2 billion more than comparable beneficiaries enrolled in the traditional fee-for-service program, according to a study by the Commonwealth Fund, the Associated Press reports. That's 12.4 percent more.

The study used data from the Medicare Payment Advisory Commission to find that payments to MA plans in 2005 exceeded fee-for-service costs for comparable beneficiaries by $922 per bene, AP says.

The study overstates the amount of payments to MA plans, Karen Ignagni, president and CEO of America's Health Insurance Plans, told AP. AHIP plans to calculate an independent estimate of the amount.

• Don't forget to use Core-Based Statistical Areas (CBSA) codes on your hospice claims, regional home health intermediary Palmetto GBA reminds providers. "The Special Blended Codes (rural state codes) made available from October 1, 2005 through September 30, 2006 are no longer valid for fiscal year 2007," Palmetto says.

• If you're a provider with claims suspended with status code "S," don't waste your time and resources trying to fix the claim, RHHI Cahaba GBA instructs.

"Generally, providers do not need to take action for claims in a suspended S/LOC," Cahaba says in its December newsletter to providers. "All claims will temporarily suspend in different S/LOCs as they process through FISS."

But wait: You do need to take action if the claim is undergoing a medical review edit, which triggers an Additional Development Request (ADR). Those claims are identified with a code starting with "SM5," Cahaba explains.

More information is at www.cahabagba.com/part_a/education_and_outreach/newsletter/1206_rhhi.pdf.

• Providers served by RHHI Associated Hospital Service should focus on denials from the Comprehensive Error Rate Testing (CERT) contractor, the intermediary urges.

"Please focus your review on the lines denied with error codes 16 (response received--improper documentation) and 21 (insufficient documentation)," AHS says in an email message. "These denials, related to insufficient or improper documentation, should be carefully reviewed to determine if additional medical records are available to support the services rendered."

• The Scooter Store will reduce its workforce by about 200 employees, the New Braunfels, TX-based firm says.

The company attributes the layoff to "Medi-care's flawed decision to significantly cut reimbursement fees for power wheelchairs (28 percent) and scooters (38 percent)."

"Medicare claims the cuts are in response to utilization spiraling out of control," company CEO Doug Harrison says in a statement about the layoffs. "The reality is that utilization of the Medicare mobility benefit has dropped almost 30 percent since 2003 and is 10 percent (12,000 units per year) below Medicare's own estimate of appropriate utilization."

Harrison also charges that Medicare's methodology for calculating the price cut "still incorporates numerous errors and does not reflect today's market price for power mobility devices."

• Sun Healthcare Group Inc. has completed the sale of SunPlus Home Health Services Inc. to AccentCare Home Health Inc., Sun says in a press release. AccentCare paid $19.5 million for the Sun home health unit with locations in California and Ohio.