Home Health & Hospice Week

Don't be surprised if you continue to see lots of home health agency claims adjustments from regional home health intermediary Palmetto GBA.

The intermediary is currently working its way through adjustments for five of the nine prospective payment system errors the Centers for Medicare & Medicaid Services identified in Oct. 31, 2008 Transmittal No. 397 (CR 6250).

Currently Palmetto is working on the 2008 PPS errors regarding: the nonroutine supply add-on that incorrectly paid for claims spanning Jan. 1, 2008; incorrectly paying the full NRS amount for an episode that should have been prorated due to a partial episode payment (PEP) adjustment; recoding certain clinical domain values; and incorrectly paying the 2007 wage index instead of the 2008 one.

And Palmetto is working on the big adjustment many agencies have been waiting for -- the correction of PPS episode sequencing. Initially, the system under PPS refinements failed to count pre-2008 episodes toward episode sequencing, paying agencies at lower early episode rates when they really should have received higher later episode rates.

"Providers will receive a high volume of adjustments reflecting a change to the original payment,"Palmetto notes on its Web site.

RHHIs originally expressed hope that they would finish the PPS refinements adjustments by the end of 2008, but Palmetto didn't begin its adjustments until February 2009.

Resource: For a list of the errors being corrected-- items 1, 4, 6, 8, and 9 in the CR--see Eli's HCW, Vol. XVII, No. 40, p. 315 or the CR at www.cms.hhs.gov/transmittals/downloads/R397OTN.pdf.

• The Senior Medicare Patrol project may be losing momentum, but it could still cause headaches for you if your patients don't understand how Medicare billing works.

In 2008, 57 Patrol projects in all 50 states and Puerto Rico had 4,685 active volunteers who educated beneficiaries in 6,869 group education sessions and held 24,505 one-on-one counseling sessions, the HHS Office of Inspector General says in a recent report. The projects also conducted media and community outreach.

The program aims to teach benes how to detect and report waste, fraud, and abuse in the Medicare program.

The programs had fewer active volunteers and saved Medicare less money than in previous years, the OIG notes. However, "the projects may not be receiving full credit for savings attributable to their work," the report cautions. Fraud and errors may be reduced "in light of Medicare beneficiaries' scrutiny of their bills."

The report is online at www.oig.hhs.gov/oei/reports/oei-02-09-00170.pdf.

• The powerful Medicare Payment Advisory Commission has appointed new members, and once again there aren't any home care industry representatives on the influential advisory body to Congress. The term of the one and only home care rep on the Commission, VNS of NY CEO Carol Raphael, expired four years ago.

One new MedPAC name might be familiar to home care providers, however. Former CMS official Herb Kuhn will finish out resigned Commissioner Jack Ebeler's term, the Government Accountability Office says in a release.

The GAO appointed one other new member for a three-year term, physician Robert Berenson from the Urban Institute. And the GAO reappointed five existing MedPAC commissioners.

• Medicare is now giving physicians the chance to designate hospice and palliative care as their specialty. Code 17 will be the new hospice code docs can choose when they self-designate their specialty on Medicare enrollment forms, CMS explains in April 24 Transmittal No. 1715 (CR 6311).

Physicians can start electing to use the code Oct. 1, CMS says in the transmittal at www.cms.hhs.gov/transmittals/downloads/R1715CP.pdf. It can be primary or secondary, points out the National Association for Home Care & Hospice.

• If you're a new supplier applying for a new National Provider Identifier number, you're already subject to Medicare's new surety bond rules for durable medical equipment. But if you're an existing supplier, you still have until Oct. 2 to get into compliance with the requirement, reminds the American Association for Homecare.

"Enrolled DMEPOS suppliers subject to the bonding requirement are required to submit a valid surety bond to the [National Supplier Clearinghouse] by October 2, 2009," AAHomecare reminds suppliers.

• Missouri wants to start charging home care providers a "provider tax." State lawmakers approved a bill, HB 740, calling for the new charge.

The tax would apply to non-federal home care service providers and would be capped at 6.5 percent, according to the bill.

• If you're looking for help with overlapping home health episodes, home health advance beneficiary notices (HH ABNs), or Reason Code 38107, one RHHI might have what you need.

Cahaba GBA has updated its quick reference tools on those topics and on-demand billing, Medicare billing codes, and PPS, the intermediary says in an e-mail to providers. A full list of the RHHI's home care tools is at www.cahabagba.com/rhhi/education/materials/quick_hha.htm.

• Suppliers that submit claims using the current 4010 for HME billing may want to tune into CMS's educational session about its replacement, the 5010. The June 9 call "will give a general overview of the transition to HIPAA Version 5010 and address some of the exceptions and situations you may encounter as the new version is implemented," CMS says in a notice to providers.

More information, including a presentation posted before the call, is online at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp.

• For-profit hospice chain Odyssey Health Care Inc. is managing its Medicare cap better, but the result may be fewer patients. The Dallas-based company lowered its cap adjustment in the quarter ended March 31, but its average daily census also fell to about 9,000 patients in the quarter, down from about 12,000 patients in the same period of 2008.

Odyssey reports net income of $8.9 million on revenues of $167.5 million for the quarter. That's compared to a $1.5 million profit on $122.8 million for the same quarter last year. Odyssey purchased competitor VistaCare in March 2008.

• University of Missouri Health Care plans to sell its Sinclair Home Care HHA to Oxford HealthCare of Springfield, reports the Columbia Tribune. CoxHealth Systems of Springfield owns Oxford, which operates in 102 counties in Kansas and Missouri.

Sinclair employs 26 people and serves 140 patients in six counties, the newspaper says.