Home Health & Hospice Week
QIO EFFECTIVENESS UNDER SCRUTINY
Powerful senator wants extensive information about your QIO.
Your Medicare Quality Improvement Organ-ization might not be helping you as much as it should, one influential senator believes.
Senate Finance Committee Chair Charles Grassley (R-IA) sent a letter Aug. 11 to Centers for Medicare & Medicaid Services Administrator Mark McClellan, requesting a plethora of information about Medicare's QIOs.
Following a recent Washington Post article and a Journal of the American Medical Association report that challenged QIOs' effectiveness (see Eli's HCW, Vol. XIV, No. 25), Grassley asked CMS for materials including current quality improvement contracts, QIO board member rosters, recent reports to Congress and a list of all QIO performance audits in the past five years.
The American Health Quality Association, the QIOs' trade group, says "the Post has done the public a disservice by presenting an incomplete and unbalanced picture of the QIO program." Recent studies show QIO assistance is "clearly helping" home health agencies and other providers furnish better care, AHQA maintains in a release.
The Institute of Medicine is currently conducting a review of the QIO program, which AHQA supports, the trade group says.
CMS will focus on specific areas, such as improving immunization in home health. The agency hopes to create performance measurement systems and increase public reporting of "expanded quality measures." To reach these goals, CMS has strengthened its Quality Council, now chaired by the CMS administrator, and formed work groups to address information technology, prevention and quality measures.
The roadmap is at www.cms.hhs.gov/quality/quality%20roadmap.pdf.
The complaint charges CMS and its contractors with conducting an illegal general investigation by targeting the top 50 or 100 power mobility suppliers in a specific region. It also claims that CMS is requiring suppliers to submit documentation to the durable medical equipment regional carriers that has yet to be approved by OMB.
CMS last August issued a proposed rule requiring physicians to document DME necessity in their medical records; meanwhile, DMERCs are demanding these unapproved records from DME suppliers.
"The OMB-approved physician's certificate has been acknowledged by both the courts and Congress as the Medicare document of record for payment of claims," PMC Counsel Stephen Azia says. The full complaint is at
Visiting Nurse Service of New York in partnership with United HealthCare Services Inc., Evercare, is in discussions with CMS regarding a ninth pilot in Brooklyn/Queens, NY, CMS adds. More information is at
"Some demand denials may not be appearing on remittance advices," Palmetto admits in a recent posting to its Web site. Providers that want the denial so they can bill another insurance must fax a request to the RHHI's provider contact center. Palmetto then will fax back a denial letter for the individual beneficiary re-quested, the posting explains.
Data analysis identified that 93 percent of CPAP claims appealed in the third quarter of 2005 were reversed as the documentation provided met the coverage criteria. Claims submitted electronically without the KX modifier will be denied as not medically necessary.
SpectraCare earlier sold its infusion and medical management business to Lake Mary, FL-based Priority Healthcare (see Eli's HCW, Vol. XIV, No. 23).
Amedisys will pay $13 million in cash for the agencies, which are expected to contribute $17 million in annual revenues.
The results reflect the cost of NationsHealth's efforts to launch a national prescription drug plan under Medicare Part D and the impact of reductions in Medicare reimbursement for respiratory medications and certain DME items that took effect earlier this year.
The quarter's profit includes a $2.7 million gain from the sale of operations in New Jersey and a $1.1 million loss from the company's BioBalance Corp. pharmaceutical unit, which hasn't yet produced any revenue.
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QIO EFFECTIVENESS UNDER SCRUTINY
Powerful senator wants extensive information about your QIO.
Your Medicare Quality Improvement Organ-ization might not be [...]
