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Home Health & Hospice Week

Industry Notes:

PROVIDER APPEALS PROCESS TO JOIN THE 21ST CENTURY

Published on Thu Jul 22, 2004

Association blasts CMS' appeals inaction.

The rules could change by the next time you take a squabble with your fiscal intermediary to the ProviderReimbursement and Review Board.

In a proposed rule published in the June 25 Federal Register, the Centers forMedicare & Medicaid Services revises, updates and clarifies various provisions of its reimbursement appeal rules.

The current principal provisions are about 25 years old. CMS says extensive litigation over important regulations -- as well as a 10,000-case backlog before the PRRB -- prove that streamlining is long overdue.

Some of the areas targeted for change include time periods and deadlines; hearing rights for providers and non-providers; "good cause" extensions; intermediary hearing officer jurisdiction; group appeals; board authority in hearing decisions; and reopened procedures.

Meanwhile, the National Association for Home Care & Hospice blasts CMS for failing to implement new appeals processes for minor claims errors and omissions, as required by the Medicare Modernization Act passed last December.

To date, CMS has only restated its current policy instead of implementing changes as required, NAHC criticizes. "CMS has failed in its responsibility to identify corrections and improve the appeals process intended by Congress," the trade association says.

  • Home health agencies and hospices can accept a physician's rubberstamp for clinical record documentation, CMS tells surveyors in a new letter. As long as state and local laws, as well as the provider's own policy, allow the signature stamp, it's OK by Medicare, CMS says in a July 8 letter (S&C-04-35).

    However, to accept the stamp, the home care provider "must obtain a signed statement from the physician attesting that he/she is the only one who has the stamp and uses it," CMS tells surveyors in the letter at www.cms.hhs.gov/medicaid/survey-cert/sc0435.pdf.

  • The HHS Office of InspectorGeneral will have a new chief if Dan Levinson's White House nomination is approved. The July 13 announcement banishes any doubts about whether acting Inspector General Dara Corrigan would stay or would go.

    Levinson has served as Inspector General and Chief of Staff of the General Services Administration. Prior positions include chairman of the Merit Systems Protection Board.

    The Inspector General oversees more than 1,500 auditors, lawyers, investigators and support staff who target fraud and abuse in the HHS programs.

  • Home Health Compare won't be the only online rating system your home care organization may be subject to. Now the Joint Commission on Accreditation of Healthcare Organizations is offering "Quality Check" at www.qualitycheck.org.

    The online system offers comparative ratings for hospitals in four areas of care -- heart attack, heart failure, pneumonia and pregnancy. But for home care providers such as HHAs, home medical equipment suppliers, hospices and infusion providers, the system indicates only whether National Patient Safety Goals have been met. Many providers'NPSG status is "not applicable."

  • Invacare Corp. is feeling the pinch of Operation Wheeler Dealer. The wheelchair manufacturer and distributor's days sales outstanding grew to 67 days in the quarter ended June 30, compared to 64 days in the same period last year. The DSO increase "resulted primarily from slower reimbursement by CMS for power wheelchair claims to home care providers," Inva-care says in its earning release.

    Medicare's pull-back of the supposedly clarified wheelchair coverage criteria in December "has not led to more stability and predictability in the power wheelchair market," Invacare laments. The company reports overall net income of $18.0 million on revenues of $339.3 million for the quarter, compared to a $15.4 million profit on $300.1 million in revenues in the year-ago quarter.

  • Option Care Inc. has acquired the infusion and specialty pharmacy division of The Care Group of Texas, reports the Houston Business Journal. The Buffalo Grove, IL-based company bought the business line from the Houston-based Care Group for an undisclosed amount.

    Option Care will integrate the business into its existing Houston operations and is offering jobs to Care Group's four infusion employees, the paper says.

  • Yet another hospital is shedding its home care business. Monterey, CA-based Community Hospital of the Monterey Peninsula will shut its home care program's doors Sept. 30, reports the Monterey County Herald. The hospital expects local HHAs Central Coast Visiting Nurse Association and Choice Home Health Care to pick up its patients, and probably many of its 57 displaced home care workers.

    The hospital's home care program, which treats an average of 170 patients per day, has been losing $2.1 million a year, the Herald says. The hospital began providing the service in 1996 when a pre-existing agency was donated to it.

  • New York Health Care Inc. will be ahome care business no longer. The company is selling the assets of its home care business for $2.7 million to a company controlled by CEO Jerry Braun and CFO Jacob Rosenberg, NYHC says in a release. The sale still must gain shareholder and regulatory approvals.

    NYHC seeks to change its name to BioBalance Holdings Inc. and focus on its pharmaceutical business. NASDAQ delisted NYHC's stock this spring following a federal indictment alleging a former director/officer and a former consultant sought to manipulate the stock (see Eli's HCW, Vol. XIII, No. 13).

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