Home Health & Hospice Week

RAPs are exempt from the hold.

If you admit and discharge a patient between Jan. 1 and Jan. 19, you might have to wait a bit on payment. Fiscal intermediaries are testing software that will implement changes from the Medicare Prescription Drug, Improvement and Modernization Act (MPDIMA), intermediaries Palmetto GBA, United Government Services and Cahaba GBA say in notices on their Web sites. They are authorized to hold all claims, except requests for anticipated payment, with dates of service beginning Jan. 1 until Jan. 19. Home health agencies should be left fairly unscathed by the hold-up, says the HomeCare Association of Louisiana in an email message to members. Home care episodes initiated prior to Jan. 1 aren't affected, a Palmetto representative told HCAL. And RAPs will continue to be processed for episodes started after Jan. 1, so only those episodes' final claims would be affected by the delay, HCAL explains. Health care consultants will want to watch closely a case against Ernst & Young that focuses on the national accounting firm's billing advice to hospital clients. A complaint filed by Pennsylvania U.S. Attorney Patrick L. Meehan alleges that Ernst's faulty billing advice to nine hospitals caused them to submit false Medicare claims for lab payments. The government is seeking to recover from Ernst more than $900,000 in damages resulting from the allegedly improper claims, according to a release. "It is the responsibility of an independent reviewer to be alert to fraud and abuse and certainly not to ignore it," said Meehan. "Ernst & Young kept itself deliberately ignorant of the facts." In a statement, Ernst said its services for the hospitals were "fully consistent with professional standards" and Medicare billing guidelines at the time, reports The New York Times. Providers can say goodbye to local medical review policies (LMRPs) and hello to local coverage determinations (LCDs). Starting last month, contractors began issuing LCDs instead of LMRPs, and launched the two-year process of converting existing LMRPs to LCDs and related articles, according to a notice on regional home health intermediary Cahaba GBA's Web site. The main difference between the two formats is "that LCDs consist only of 'reasonable and necessary' information, while LMRPs may also contain category or statutory provisions," according to Cahaba. "Any non-reasonable and necessary language a contractor wishes to communicate to providers must be done through an article," the RHHI explains. The home care waiver program in Pennsylvania has saved the state an estimated $3.8 million in nursing home costs, reports the Philadelphia Inquirer. And some changes to the program may cause home care utilization and the resulting savings to grow. The state has raised from $2,000 to $8,000 the asset amount a Medicaid beneficiary may possess and [...]