Home Health & Hospice Week

Even if you don't win a contract under competitive bidding, you can still furnish durable medical equipment or oxygen to your existing clients.

So confirms the 2010 physician fee schedule final rule, scheduled for the Nov. 25 Federal Register. But the decision comes with extra headaches. Suppliers will have to notify in writing both their patients in the bidding area and the Centers for Medicare & Medicaid Services, if they wish to continue furnishing bid items as noncontract suppliers, CMS specifies in the rule.

Fine print: But suppliers can't pick and choose which items or which patients to grandfather, CMS cautions. "Suppliers that agree to be a grandfathered supplier for an item must agree to be a grandfathered supplier for all current beneficiaries who request to continue to rent that item from them," the rule explains. And suppliers must furnish all items in a bid category.

In the rule CMS also spells out payments for maintenance and service of oxygen equipment and the process for requesting damages for canceled round one bidding contracts, the American Association for Homecare points out.

The rule is at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.

• Home health agencies are responsible for one more supply code under consolidated billing. CMS added two new HCPCS codes to the bundling list, which specifies which supplies HHAs must pay for out of their prospective payment system rate: A4360 (disposable external urethral clamp or compression device with pad and/or pouch, each) and A4456 (adhesive remover, wipes, any type).

"Code A4456 is a new code that replaces code A4365," CMS notes in Transmittal No. 1827 (CR 6662). The deleted code was for ostomy adhesive remover wipes, CMS notes in the reissued transmittal.

• You'll have to pay attention to a new deadline for electronic data interchange (EDI) enrollment forms, if National Government Services is your intermediary. Providers must sign and fax all EDI forms "within 10 business days," NGS says in an email message. "Any forms that are not signed and faxed to National Government Services within those 10 business days will be rejected."

Watch out: Your billing service can't sign the forms for you, NGS warns. Forms affected include those for claims status inquiry and provider logon request.

• Suppliers wondering how to handle claims for patients whose previous suppliers went bankrupt now have an answer, but the industry may not like it. Suppliers will get paid for oxygen equipment only if the patient's old equipment is declared "lost," CMS says in a listserv message to providers.

Equipment furnished by bankrupt suppliers is considered lost if the company filed for Chapter 7 bankruptcy, CMS explains. If the supplier filed for Chapter 11 bankruptcy, the equipment must have also been sold or at least be scheduled to be sold.

When submitting a claim for such equipment, suppliers must include a new certificate of medical necessity (CMN), an RA HCPCS modifier, and a narrative describing what type of bankruptcy the former supplier filed, CMS says.

Suppliers also have to submit documentation proving the previous suppliers' bankruptcy, including court filings and, for Chapter 11, documents confirming the equipment's sale.

"A new 36 month rental period and a new reasonable useful lifetime will not begin unless this documentation is made available to the contractor and, in the case of a Chapter 11 bankruptcy, the contractor is able to verify that the oxygen equipment that was being furnished to the beneficiary was one of the assets that was liquidated," CMS warns in the message.

Watch for: CMS will issue a new transmittal and MLN Matters article on this topic soon, the agency promises.

• The feds knocking on your door isn't a disaster if you've minded your p's and q's. The HHS Office of Inspector General reviewed Kentucky Medicaid payments for HHA services to Gentiva Health Services Inc. from 2007, the OIG says in a new report.

The OIG targeted Gentiva because it "had the highest amount of paid Medicaid Home Health Agency (HHA) claims in Kentucky" during the year, the OIG notes in the report -- 25,597 claims totaling $5.15 million.

The Medicaid program's payments to Gentiva were all OK by the OIG. "Medicaid payments that the Kentucky Department for Medicaid Services made to Gentiva for HHA services for all the sampled claims were in accordance with the State's Medicaid requirements," says the report at www.oig.hhs.gov/oas/reports/region4/40906012.pdf.

Kentucky doesn't have requirements like being homebound or requiring a skilled need, the OIG added.

• If a new NIH-funded trial is successful, home care providers may have a new service to offer private-paying seniors.

The National Institutes of Health's National Institute on Aging is giving nearly $30 million to a trial "to determine whether a specific physical activity program can stave off disability in older people," the NIH says in a release. The "Lifestyle Interventions and Independence for Elders -- LIFE" trial will aim to "prevent mobility disability among older people who are at risk of losing their ability to walk and to live independently in the community." Funds for the six-year, eight-site trial run by the University of Florida's Institute on Aging in Gainesville are coming from last year's stimulus bill funds, NIH notes.

"There is a lot of evidence indicating that exercise can help in preventing diseases, such as diabetes, among older people. But we do not know whether and how a specific regimen might prevent walking disability in older people who are at risk of losing mobility," NIA Director and physician Richard J. Hodes says in the release. "This research is critically important at a time when the population is aging and new interventions should be sought to keep people healthy and functioning in the community longer."

"Arthritis, muscle weakness and poor balance can all affect how well and how far a person can walk," says physician Jack Guralnik, chief of the NIA's Laboratory of Epidemiology, Demo-graphy and Biometry and co-principal investigator of the study. "We will test the LIFE intervention in this population to see how it works in a real-world setting," he says.

• You may have to wait on payments for flu vaccinations given since Oct. 1.  Some claims for the vaccinations have been incorrectly paid, Cahaba explains on its Web site. Until the issue is resolved, the intermediary is holding the claims.

• Don't be surprised if you start encountering more oversight from the feds and other enforcement agencies. Everyone from President Obama to local officials are calling for curbing fraud, waste, and abuse in Medicare, Medicaid and other public insurance programs to slow growing health care costs.

A recent AARP survey of people 65 and older revealed the degree to which seniors have experienced various forms of waste, fraud, and abuse within Medicare. The telephone interviews were conducted for AARP in July and August on a nationally representative sample of 624 Americans aged 65 and older, including 112 Hispanics. Results showed a significant number of respondents that reported having experienced specific forms of waste, fraud and abuse.

Watch out: Durable medical equipment suppliers might be especially vulnerable to new  fraud crackdowns, the survey suggests. Nine percent of respondents report that they or somebody else that they know on Medicare have had someone try to sell them Medicare medical supplies (such as electronic mobility scooters, diabetes test strips, etc.) that were not truly needed to improve their health or conditions.

And 7 percent of respondents report that they or somebody else that they know on Medicare have received a medical bill for tests or treatments that they actually did not receive.

Eighty percent reported that eliminating waste, fraud, and abuse in Medicare should be at least one of the top priorities in healthcare reform.

• The urgency to get your patient population vaccinated against swine flu may be less intense than you expected. That's because H1N1 is proving riskier for younger patients.

"When we look more closely at our cases and hospitalizations, we are continuing to see this focus on younger people. Sixty percent of the cases and 42 percent of hospitalizations have occurred in people between the ages of 5 and 24 years," says physician Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.

"This is quite different than what we see with seasonal influenza where the highest hospitalization rates are in the elderly. We have very low rates of hospitalization in cases in people 65 and over," says Schuchat.

• LHC Group Inc. has increased its presence in a certificate of need (CON) state.The Lafayette, La.-based chain entered into a home health joint venture with Twin Lakes Regional Medical Center in Leitchfield, Ky., the company says in a release. The agency's annual revenue is about $640,000.

LHC Group also has completed the acquisition of the assets of Feliciana Home Health. Feliciana, with annual revenues of $12 million, serves patients in Baton Rouge, La. and the surrounding area, the chain says in the release.