Home Health & Hospice Week

PEPs come into play.  Payments for Medicare patients don't necessarily stop when a provider terminates its agreement with the program. If a home health episode is established before the termination date, Medicare will pay for care up to 30 days after that date. When the 60-day episode ends before those 30 days are up, a home health agency will receive the full episode amount, the Centers for Medicare & Medicaid Services says in a revision to the new online Medicare Claims Processing Manual. But when the episode exceeds the 30-day limit, the payment system will apply a partial episode payment (PEP) adjustment to the episode, ending it within the allowed time period, according to Transmittal No. 17, dated Oct. 31. Chances of passage for the pending Medicare legislation look slimmer than ever. Lawmakers can't seem to agree on key provisions of the prescription drug package, which is included with other Medicare changes in the bill. Congress currently plans to adjourn for the year on Nov. 21, although legislators already are calling that date into question. If the bill sinks, durable medical equipment suppliers are likely to avoid a proposal that the American Association for Homecare says includes: payment reductions to the top five DME items and services including oxygen and wheelchairs; a two-year phase in of competitive bidding for non-rural areas starting in 2007; and a four-year freeze to inflation updates. HHAs would dodge a reduction to inflation updates, but would also lose a 5 percent add-on for rural payments. Empire State DME suppliers may see tightened rules at best and recoupments at worst for items that are supposed to be bundled into Medicaid skilled nursing facility payments. New York paid suppliers $1.2 million for DME and supplies that should have been billed to SNFs as part of their payment rates rather than the Medicaid program, the HHS Office of Inspector General says in a recent report. One major culprit might be "augmentative communications devices," the report indicates. Since they aren't custom-made, they aren't separately billable, the OIG instructs. The watchdog agency wants the state to take a number of steps to curb the overpayments, including having Medicaid reviewers performing the prior approval for the item also determine who is responsible for payment - and thus who the supplier must bill - the SNF or Medicaid program. The report is at http://oig.hhs.gov/oas/reports/region2/20201025.pdf. If you don't have these nine abbreviations on your "do not use list" starting Jan. 1, you'll see dings on your next Joint Commission on Accreditation of Healthcare Organizations survey: U, IU, Q.D, Q.O.D, trailing zero (X.0), lack of leading zero (.X), MS, MSO4, and MgSO4. And if you don't have three more abbreviations on the "do [...]