Industry Notes:
RHHI TARGETS HOSPICE CANCER CLAIMS
Published on Mon Feb 09, 2009
Reviewers shoot down claims for certification,terminal prognosis problems.
You could wind up owing money back to Medicare if your documentation on myeloma and lymphoma patients is sloppy.
Regional home health intermediary
Cahaba GBA is launching a widespread review of hospice claims with diagnoses of 202.xx (Other malignant neoplasms of lymphoid and histiocytic tissue) and 203.xx (Multiple myeloma) and with lengths of stay greater than 180 days.
In a probe review, Cahaba reviewers shot down most claims due to "missing, incomplete or untimely certifications and the six-month terminal prognosis not being supported in the medical record," the intermediary says in its March newsletter to providers.
Tip #1:
The cert period dates must be clearly identified on the form, Cahaba instructs. "Simply having the statement 'third benefit period' is not enough to be able to tell which certification period the physician is signing," it says.
Tip #2:
Don't rely on your diagnosis codes to show why hospice is appropriate for the patient,Cahaba warns. Your documentation should "paint the picture."
Tool:
To boost your documentation, make use of Cahaba's hospice documentation checklist at www.cahabagba.com/rhhi/education/materials/quick_hospice_doc.pdf.
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Better late than never, Zone Program Integrity Contractor (ZPIC) Health Integrity has announced it began operating in Zone 4 (Colorado,New Mexico, Oklahoma, and Texas) last month,according to Palmetto GBA's March newsletter.
ZPICs are taking over many of the fraud and abuse-related activities from the current intermediaries and carriers. For all providers in those states including home health agencies, hospices, and durable medical equipment suppliers, HI will perform data mining and analysis, conduct benefit integrity focused medical review, investigate fraud and abuse,recommend funds recovery, and work with and refer cases to law enforcement, the contractor says on its Web site.
Easton, Md.-based HI has local offices in each state, it says. "Health Integrity staff include data analysts, nurse reviewers, and fraud investigators," it says on its site at www.healthintegrity.org.
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Despite some vague statements from the Centers for Medicare & Medicaid Services at the Feb. 18 Open Door Forum for home care providers,CMS's surety bond regulation for durable medical equipment suppliers is not on hold, the American Association for Homecare reports.
"CMS intends to follow through with the implementation dates" listed in the Jan. 2
Federal Register notice, AAHomecare says in a message to members. New suppliers or those seeking change of ownership need a $50,000 bond by May 4, CMS says in the rule. Existing suppliers need a bond by Oct. 2.
Expect more surety bond guidance from CMS soon, AAHomecare says.
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Members of Congress are getting their home care hopes onto the record. Sen. John Thune (R-S.D.) has reintroduced a bill (S. 457) that would create a pilot program giving HHAs incentives to use telehealth technology.
"Telehealth technology has the ability to dramatically change the way people in rural areas access high-quality health care," Sen. Thune says in a release.
And Rep.
John Lewis (D-Ga.) has reintroduced legislation (H.R. 1094) that would allow occupational therapists to make initial assessment visits for home care episodes, when OT is ordered in a therapy-only episode along with PT or SLP. The bill aims to let HHAs "assign the most appropriate skilled service to make the initial assessment visit," Rep. Lewis says in a release.
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You'll have to change your NPPES password after system updates taking place March 7. The National Plan and Provider Enumeration System which houses the National Provider Identifier database will enforce an eight-character password minimum, CMS says.
The updates will also restore the "doing business as (DBA)" search feature, update the NPI registry daily, and display results in all capital letters, CMS adds.
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Starting July 7, you should begin seeing your NPI on all paperwork from the National Supplier Clearinghouse. A Feb. 27 transmittal (CR 6314, Transmittal No. 451) from CMS instructs the NSC to "insert the NPI into all correspondence, including pre-printed re-enrollment packages."
The NSC will also validate all NPIs received from suppliers starting in July, says the transmittal online at www.cms.hhs.gov/transmittals/downloads/R451OTN.pdf.
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Beware losing money to cheating employees. Newark-based Hospice of Central Ohio has learned that lesson the hard way. An employee of the hospice stole more than $450,000 from the provider over five years, reports theNewark Advocate.
Kathleen Lee
wrote checks to herself from the hospice's operating account from 2003 to 2008,says the Columbus Dispatch. She was finally caught when a suspicious bank employee reported one of the checks to superiors. She was sentenced to sevenyears in prison.
Originally, authorities thought Lee spent all the money on credit cards and rent. But the hospice now claims in a civil law suit that Lee has an open account in at least one bank, says the
Advocate.
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New York's crackdown on home health aide-related fraud continues, this time with aide training facility Global Health Care Training Center as the focus.
Under "Operation Home Alone," authorities arrested owner/operator
Wayne Lynch and employee Charles Trevor, says Attorney General Andrew M. Cuomo in a release. They were charged with grand larceny, a felony, for their involvement in providing bogus aide certifications.
Global sold the false certifications for $300 without providing the RN training required, prosecutors say.
The campaign has resulted in charges against 100 defendants and restitution of $34 million so far, Cuomo notes.
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A participant in a DME scam in South Florida received a prison sentence of more than 11 years for his part in the scheme. In December, a jury convicted Jimmy A. Soto for Medicare fraud and money laundering charges, notes Florida U.S. Attorney R. Alexander Acosta.
Soto and co-conspirators
Leonardo Lozada, Eliades Diaz, and Jose D. Claro through sham DME company Med-Pro of Miami, Inc. submitted $5.4 million in DME claims for items they never provided, prosecutors say. Medicare paid Med-Pro about $1.3 million based on the bogus claims, which were for DME that was neither prescribed by doctors nor delivered to Medicare patients.
The
FBI found out about the scam when numerous Florida residents contacted them to complain about Med-Pro's submission of fraudulent claims to Medicare. Diaz was sentenced to 80 months in prison, Lozada was sentenced to 46 months, and Claro was sentenced to 31 months, Acosta adds.
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A Minnesota home health agency owner must serve 18 months in prison and three years of supervised release, and must pay $350,000 in restitution for Medicaid fraud.
Zimmerman, Minn.-based
Allied Home Health Care Services owner Michelle Barbara Pundt pled guilty to submitting Medicaid claims that overstated private duty nursing service units provided to clients, according to a release from Minnesota U.S. Attorney Frank Magill.
