Home Health & Hospice Week

OIG yanks controversial regulation.

You don't have to worry about a proposed rule from the HHS Office of Inspector General that would have punished Medicare providers for submitting excessive charges. The OIG withdrew the rule, which it proposed in 2003, in a June 18 Federal Register notice.

The OIG rule said charges greater than 120 percent of a usual charge would be excessive, notes the American Association for Homecare. Now the OIG says it does "not have sufficient information ... to establish a single, fixed numerical benchmark for 'substantially in excess' that could be applied equitably across health care sectors and across items and services," according to the notice.

AAHomecare cheers the withdrawal, noting that "the proposed rule incorrectly assumes that the benefit structure and payment methodology used by the Medicare program is directly comparable with that of the private sector."

Furthermore, the proposed rule was "arbitrary" and lacked "empirical basis," the trade group says.

• A study analyzing the impact of OASIS data collection for private pay patients doesn't give any clear indicators of which way CMS may eventually rule on the matter. CMS suspended OASIS data collection for private pay patients in 2003 (see Eli's HCW, Vol. XII, No. 41). But the agency warned at that time that it could reinstate the practice at a moment's notice.

OASIS contractor Abt Associates completed the study in December 2005 but CMS posted the report on its OASIS Web site only recently. The report lists pros and cons for making the suspension permanent and reinstating the requirement. Mandating OASIS for all patients could improve patient outcomes, but would burden providers, patients and payors, the study says.

The study is at www.cms.hhs.gov/OASIS/03_Regulations.asp under the "Downloads" section.

• Don't be surprised if you encounter some senior clients who are having trouble disenrolling from private Medicare Advantage plans--a big problem for agencies in securing payment for home health services.

Seniors have the right to withdraw from the plans if they were misled or given incorrect information about benefits. But a recent report from the Lexington Herald-Leader suggests that problems persist as seniors try to get their benefits back on track.

"[H]undreds" of elderly residents have contacted the Medicare Rights Center because they cannot disenroll from a private MA plan purchased "as a result of misleading sales tactics," the paper reports.

• Physicians who refer Medicare patients to home care will see a 9.9 percent cut to their home care-related payments next year. That's if Congress fails to provide more funding for Medicare physician payment rates. Some docs requested that CMS increase the work Relative Value Units for home visits (HCPCS codes 99343-99350). But CMS decided to keep the work RVUs the same for the services in 2008, according to the recently proposed physician fee schedule.

Watch out: A fix to the payment cut may encourage docs to refer patients to home care, but is likely to result in payment cuts for home health agencies, hospices and durable medical equipment suppliers instead, experts warn.

• CMS will give some patients access to a Personal Health Record (PHR) as part of a pilot program. The beneficiaries will be able to access their health records online through www.mymedicare.gov, including medical conditions, hospitalizations and physician visits. CMS hopes the information will help patients to manage their own care, the agency says.

• If a flood of secondary insurance notices to your patients is making big headaches for you, you're not alone. "Medigap and other supplemental insurers are sending unnecessary notices that are confusing patients and generating inquiries to home health agencies about the status of claims," notes the Connecticut Association for Home Care. A claims system change made this spring is behind the change, the trade group notes.

"By October, CMS will instruct supplemental payers of steps to take to send notices only when co-insurance is required," CAHC says.

• The clock is ticking on any Comprehensive Error Rate Testing (CERT) documentation requests you have received. "It is MANDATORY that you respond" by July 25 to CERT requests for claims from April 1, 2006 through March 31, 2007, regional home health intermediary National Government Services says in a message to providers.

The CERT contractor will use the medical review to report the Medicare payment error rate to Congress, NGS notes. "It is crucial that you respond with the appropriate records to support the medical necessity for the item and/or service being provided."

Providers will receive denials for non-response or insufficient documentation, the RHHI adds.

• Regional chain LHC Group is teaming up with yet another hospital to run a home health agency. LHC has entered into a partnership with The University of Tennessee Medical Center in Knoxville and will run the day-to-day operations of the HHA. LHC will now serve 26 counties in the state, the Lafayette, LA-based company says in a release.

LHC also purchased Wetzel County Home Care in New Martinsville, WV for undisclosed terms. LHC will now serve 24 counties in the state from five locations, the company says in the release.

• A Michigan federal jury found former HHA owner Jesse Cruz guilty of four felony counts July 3. The former owner of Autumn Ridge Home Health Care was convicted of concealing the role of co-defendant Elena Szilvagyi on a Medicare fraud application and hiding the fact that his company's start-up funds were siphoned off from her company, Prime Care Services, which owed Medicare more than $7 million, according to the Royal Oak Daily Tribune.

Szilvagyi and her husband pled guilty in 2004 to Medicare fraud charges, including paying for their house to be built with cost report fraud (see Eli's HCW, Vol. XIII, No. 7). Szilvagyi also pled guilty to more Medicare fraud charges in 2006, was fined millions of dollars in a civil lawsuit and is serving a prison sentence. She testified against former employee Cruz in the trial, the newspaper says.