Home Health & Hospice Week

Durable medical equipment suppliers are the least happy of all Medicare provider types with their contractors.

That's according to the latest Medicare Contractor Provider Satisfaction Survey (MCPSS) commissioned by the Centers for Medicare & Medicaid Services. The survey conducted by MCPSS contractor Westat polled 35,000 randomly selected providers in its third year.

Physician DME suppliers submitting DME claims report the lowest level of satisfaction at 4.22 on a 1 to 6 scale, while hospices had the highest level of satisfaction at 4.74, the report says.

Of the four categories of contractors, Regional Home Health Intermediaries (RHHIs) received the highest average score -- 4.68, the re-port says. DME Medicare Administrative Contract-ors (DME MACs) received an average score of 4.41, which was higher than Carriers and Part B MACs with an average score of 4.35.

Overall, contractors received a 4.51 score, which equals a 75 percent "C" average. That's down a bit from last year's 4.77 score.

For RHHIs, the lowest overall score is 4.54 for National Government Services (formerly UGS) while the highest score is 4.86 for Cahaba GBA. "As in the previous two national administrations of the MCPSS, the RHHIs score high and all have scores above the national average," the report notes. Last year Palmetto GBA took the high-scoring honors.

For DME MACs, the lowest overall score is 4.36 for CIGNA and the highest score is 4.45 for Noridian. "DME MACs tend to have lower scores than average; all four have scores below the national average," the report notes.

More information including the survey results report is at http://www.cms.hhs.gov/MCPSS.

• It may seem really convenient for your patients to have all their health care providers in one building, but it could pose a major problem for you if you're the landlord.

The HHS Office of Inspector General handed down an Aug. 26 advisory opinion concerning renting space to referring physicians and it was not favorable.

According to the OIG report, a freestanding cancer clinic offers many services, including intensity-modulated radiation therapy (IMRT), which is common in treating prostate cancer. Some urologists refer their patients to the cancer facility for their IMRT treatments.

Therefore, the clinic suggested an arrangement where the urologists would lease space in its building and provide personnel and equipment, allowing the urologists to treat patients and provide IMRT. In exchange, the urology group would pay the cancer center rent and other expenses.

The decision: The OIG determined that the arrangement "could potentially generate prohibited remuneration under the anti-kickback statute."

The urologists' business in this case would be dependent on referrals from, or other business generated by, the urologist's existing patient base, says attorney Emily Kretchmer of Pierce and Mandell in Boston. "The contemplated relationship would allow the urologists to capture revenue from referrals that they would not otherwise be entitled to without any real business or financial, capital or human resources commitment."

To read the advisory opinion, go to www.oig.hhs.gov/fraud/docs/advisoryopinions/2008/AdvOpn08-10A.pdf.

• Have you been wanting to give CMS a piece of your mind? Now's your chance.

CMS is holding a town hall meeting Sept. 22 to gather feedback on "relevant Fee-for-Service (FFS) Medicare policy and operational issues," the agency says.

The agency will make presentations on HIPAA standards, recovery audit contractors (RACs) and Medicare administrative contractor (MAC) transitions, it says.

More information, including how to sign up, is at http://www.cms.hhs.gov/center/provider.asp under the "Spotlights" section.

• CMS has tweaked its contractor instructions for the new CPAP coverage criteria. CMS changed the coverage criteria with a July National Coverage Determination.

CMS "clarified" some "verbiage" about the continuous positive airway pressure device policy, it says in the Aug. 29 transmittal at http://www.cms.hhs.gov/transmittals/downloads/R94NCD.pdf.

An American Association for Homecare rep registered alarm about CPAP coverage changes in last month's Open Door Forum for home care.

• Providers with pending Provider Reim-bursement Review Board decisions have another four months before their preliminary position papers are due, the National Association for Home Care & Hospice reports. On Aug. 21, new PRRB regulations and rules went into place. CMS published the rules in the May 23 Federal Register.

"Due to the significant changes in the new rules, the PRRB has automatically extended position paper due dates for providers that received acknowledgement letters prior to Aug. 21," NAHC says. That goes only for cases that had preliminary or final position paper deadlines after Sept. 1.

• DME industry reps are calling for quicker accreditation of suppliers in light of two recent federal reports unflattering to the sector.

The OIG and the Government Accounting Office both took aim at CMS in recent reports. The OIG chastised CMS for under-reporting DME payment error rates and the GAO slammed the agency and the National Supplier Clearinghouse for lax supplier enrollment procedures.

"Congress should make it clear to CMS that the delaying of competitive bidding was not meant to delay any mandatory accreditation requirements that can be useful in the fight against fraud," says the Power Mobility Coalition's Eric Sokol in a release. "PMC strongly urges that a new phase-in schedule should be developed and implemented immediately."

"All legitimate DME suppliers have an interest in ridding the Medicare program of bad actors," attorney Stephen Azia explains. "Accred-itation is a powerful tool that will help in eradicating the fraudsters, save the Medicare program and American taxpayer's money and ensure that eligible beneficiaries receive quality medical equipment from lawful suppliers," says the PMC counsel.

• An HHA owner has been sentenced to prison and millions in restitution after pleading guilty to Medicare fraud, while his attorney received home confinement and millions more in restitution.

Floyd Siebert concealed his relationship with his various business entities, located across Texas, Oklahoma, Nevada and Florida, and "sold" goods and services from one of his companies to another of his companies at inflated costs, improperly passing the inflated costs on to Medicare, prosecutors charged. He also fraudulently passed on non-Medicare costs to the program.

And Siebert embezzled $3.9 million from employees' medical and pension plans and put it in a shell corporation set up by attorney James E. Golden Jr. That corporation then lent the money back to the HHAs and charged them interest.

Siebert pled guilty to health care and pension fraud and was sentenced to 46 months in prison and $5.7 million in restitution last year, the U.S. Attorney's office for the Southern District of Iowa says in an Aug. 30 release. Golden pled guilty to misprision of a felony and was sentenced to three years probation, five months home confinement and the same amount of restitution to Medicare and the pension fund, $5.7 million.

• LHC Group Inc. has made two buys in West Virginia. The Lafayette, LA-based chain ac-quired Mountaineer Home Health located in Char-leston, which will operate under the name of Moun-taineer HomeCare. And LHC bought the HHA of the Jackson County Board of Health in Ripley. That agency will operate under the name of Jackson County Home Health.

The two agencies have a combined annual revenue of $1.3 million, LHC says in a release. LHC now operates 12 agencies covering 31 counties in the Certificate of Need state.

The company also opened two new locations in Martin, TN, and Owensboro, KY last month, it says.