Home Health & Hospice Week

Get ready for 2 more quality measures.

If you're in doubt that OASIS will be more important than ever under the new prospective payment system refinements, just look at some of the coming PPS changes.

Quality measures: The PPS refinements final rule that the Centers for Medicare & Medicaid Services released Aug. 22 adds two new publicly reported quality measures in 2008. That's in addition to the 10 already reported on Home Health Compare, for a total of 12 measures, noted CMS' Randy Throndset in the Aug. 29 Open Door Forum for home care providers. These additional measures are "Emergent care for wound infections, deteriorating wound status" and "Improvement in status of surgical wounds."

Pressure ulcer staging: CMS clarifies that it has revised the instructions for OASIS item M0460 that requires staging pressure ulcers. Instructions now "allow a wound to be staged if the bed of the wound is partially covered by necrotic tissue and if the presence of eschar does not obscure the depth of the tissue loss," the final rule states (see Eli's HCW, Vol. XVI, No. 27).

OASIS form: The PPS rule doesn't finalize the actual changes to the OASIS form, Throndset explained in the forum. Those revisions, which must go through the Paperwork Reduction Act process, will be finalized and posted "very soon," he promised. Among the changes are the new therapy item (M0826) that asks for the specific number of therapy visits instead of whether the visits will exceed the therapy threshold.

• Veterans who live in New Jersey may soon have an easier time receiving home care. In August, Gov. Jon Corzine (D) signed into law a bill that directs the state adjutant general to evaluate the costs and benefits of providing home care aides to veterans who are elderly or disabled.

The report, due to the state legislators within six months, must make specific recommendations on state funding that would be needed to meet the added demand for home care services. The report must also address how the program would work with Medicare, Medicaid and private health insurance.

"It's important that we explore and consider new options for our veterans who require prolonged medical care," Corzine said in a release. "These alternative programs have the potential to allow veterans to receive the care they need from the comfort of their home while at the same time reducing the long-term demands of the (state)."

• National Provider Identifier problems won't be limited to Part A providers anymore. Between Sept. 3 and Oct. 29, all Durable Medical Equipment Medicare Administrative Carriers (DME MACs) and Part B carriers "will begin to turn on edits to validate the NPI/Legacy pairs submitted on claims," CMS explains in an email to providers. "If the pair is not found on the Medicare NPI crosswalk, the claim will reject."

Don't miss: Make sure your information is correct in the National Plan and Provider Enumeration System. "If you are receiving informational edits today, we strongly urge you to validate that the NPPES has ALL of the NPI and legacy numbers you intend to use on claims and for billing purposes," CMS says.

• Your long-stay hospice claims are about to go under the microscope. Regional home health intermediary Cahaba GBA is getting ready to launch a widespread review of hospice claims with a routine level of care and a length of stay greater than two years, the intermediary says in a message to providers.

The topic code for this review will be 5003W, the intermediary says. Reviewers will examine claims for medical necessity.

• The home care industry continues to get a black eye in high-profile coverage of New York's crackdown on home health aide fraud (see Eli's HCW, Vol. XVI, No. 30). Home care is "a burgeoning industry that is ineffectively regulated, that is expensive for taxpayers, and can victimize consumers," state Attorney General Andrew Cuomo told The New York Times in its most recent story in a series.

"When he took office in January, Governor [Eliot] Spitzer recognized that oversight of home health care agencies ... did not receive the appropriate level of commitment of resources over the last 12 years," said a spokesperson for the state's Health Department.

Cuomo issued subpoenas to dozens of home health agencies last month. New York HHAs can expect forthcoming legislative and regulatory changes aimed at the industry, including a centralized registry for aides, the Times indicated.

HHAs rely on the state to ensure agencies with whom they contract for aides and aide certification are operating properly, noted Joanne Cunningham of the Home Care Association of New York State.

• Pediatric Services of America Inc. has now gone private. Private investment firm Portfolio Logic completed its acquisition of the Norcross, GA-based company, PSA says in a release.

• LHC Group. Inc. is acquiring Extendicare of West Tennessee, which has home health agencies in Jackson, Union City, Paris and Henderson. Extendicare covers 21 counties in the state, the Lafayette, LA-based chain says in a release. LHC will now serve 42 counties in Tennessee.

LHC also inked two more hospital deals. The company will form a partnership with Columbus Regional Medical Center in Columbus, GA by selling a 33 percent interest in its Pine Mountain, GA location to the hospital. And LHC will convert a current lease agreement to a joint venture with Mississippi Baptist Medical Center in Jackson, the company says.