Home Health & Hospice Week

COPs, hospice-nursing home guidance also slated for this year.

Home health agencies may have to wait until almost the end of the year to see the changes coming to the prospective payment system, including the much-anticipated therapy threshold change.

A Centers for Medicare & Medicaid Services official announced at March's National Association for Home Care & Hospice policy conference that CMS planned to issue the proposed rule on PPS refinements some time this year (see Eli's HCW, Vol. XV, No. 13).

Now CMS has slated the rule to come out in November and take effect in January 2008, the agency says in the Department of Health and Human Services semiannual regulatory agenda, published in the April 24 Federal Register.

The rule will propose "the first major refinement to the HH PPS since its implementation on 10/1/ 01," CMS says in the notice.

Keep watch: However, CMS' agenda timelines regularly get delayed, observers warn.

CMS also sets October as the new release date for the re-proposed home health conditions of participation (COPs) and the release date for proposed hospice requirements for long-term care facilities. CMS sets May 2008 as the date for the final rule on the hospice COPs it proposed last year.

• A federal rule will target health care fraud by standardizing existing Medicare enrollment requirements used by the various Medicare contractors that process and pay Medicare claims.

"By standardizing the information that a health care provider or supplier must use in order to bill Medicare, we will be better able to protect the Medicare program and assure providers and suppliers that they will be paid promptly," says Timothy Hill, chief financial officer and director in CMS' Office of Financial Management. Among the provisions of the April 20 rule: Most providers must report changes in enrollment data within 90 days of a change, but durable medical equipment suppliers will have only 30 days to notify their CMS contractors.

More information on Medicare enrollment is at www.cms.hhs.gov/MedicareProviderSupEnroll.

• A probe review of claims with long-term drug use code V58.69 has blown up into a widespread review for all HHAs served by regional home health intermediary Cahaba GBA. Starting last December, providers could report codes from this series only as secondary diagnoses.

Cahaba conducted a probe review of claims with the code from Sept. 21 to Dec. 12--mostly before the primary diagnosis code prohibition took effect. Even so, the probe of 50 providers' claims found an error rate of 47 percent, Cahaba says in an April 25 posting to its Web site.

"The largest reasons for denials were related to the lack of documentation to show this was an effective treatment for the beneficiary's condition, or because there was an oral alternative, and no documentation why the oral medication wasn't used," Cahaba notes.

Due to the probe's high error rate finding, Cahaba will initiate a widespread review of claims with V58.69 as primary and a length of stay greater than 60 days, the RHHI says. More information is at www.cahabagba.com/part_a/whats_new/20060425_probe.htm.

• Senators soon will urge their leaders to reject an HHA Medicare rate freeze for 2007. Both President Bush and the Medicare Payment Advisory Commission have recommended the freeze, notes the American Association for Homecare.

Sen. Susan Collins (R-ME) and Russell Feingold (D-WI) are rounding up bipartisan support for a letter to Senate Finance Committee Chair Charles Grassley (R-IA) and Ranking Member Max Baucus (D-MT). The letter cites rising transportation, technology and staffing costs and stresses home care's cost-effective treatment setting.

Twenty-three senators have signed onto the letter so far, the National Association for Home Care & Hospice reports. But only five of those are Republicans.

• Two private equity firms, Los Angeles-based Oaktree Capital Management and New York-based MTS Health Investors, have bought the stake in Clearwater, FL-based Senior Home Care previously held by Summit Partners, reports the Tampa Bay Business Journal. Senior Home Care management retains an ownership position as well.

The deal closed March 31 for undisclosed terms, the Journal says. Summit paid $30 million when it became majority Senior Home Care shareholder in 2003.

Senior Home Care plans to continue expanding statewide and, in the long term, into Alabama and Georgia, CEO Mac McCleary told the paper. The company derives 98 percent of its revenues from Medicare and has nearly 1,800 employees in 22 Florida locations.

• Amedisys' net income was flat while its revenues boomed in the quarter ended March 31. The Baton Rouge, LA-based regional provider reported net income of $7.3 million on revenues of $127.2 million for the quarter, compared to a $7.1 million profit on $70.4 million in revenues for the year-ago quarter.

Amedisys management is trying to improve operating results from acquisitions, the company says in a release. Amedisys acquired 66-location Housecall Medical Resources Inc. last year. Management is also streamlining corporate office functions.

• Dallas-based Odyssey HealthCare Inc. beat analysts' estimates for earnings in the quarter ended March 31. The for-profit hospice chain reported net income of $5.8 million on revenues of $103.6 million, compared to a $5.3 million profit on $87.8 million in revenues for the same period in 2005.

The company has reduced the adjustment it has to take over Medicare per-patient cap overages, CEO Robert A. Lefton says in a release.

• Four California residents have been convicted on federal charges of billing Medicare more than $24 million for nutrition products and motorized wheelchairs that were not medically necessary and, in many cases, were never provided. Ten defendants were indicted in a scheme to recruit patients and drive them to see doctors who prescribed the unnecessary equipment, according to U.S. Attorney for the Central District of California Debra Wong Yang.

Yang announced the convictions of PhMo Thi Pham and Peter Kim. Four defendants already plead guilty, one defendant, a physician, will stand trial in July and one defendant, another u Luong, operator of United Medical Supply in Huntington Beach, Luong's partner Sareth Tath, and Tath employees physician, remains a fugitive.

The conviction follows a three-week trial in Santa Ana before a federal jury. Each defendant was convicted of 35 counts of health care fraud.