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Home Health & Hospice Week

Industry Notes:

Rules For Terminated HHAs Brought In Line With PPS

Published on Thu Nov 13, 2003

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 not use" list by April 1, preferably from JCAHO's other suggestions, you'll also be in a world of hurt regarding this National Patient Safety Goal from the Oakbrook Terrace, IL-based accrediting body.

    Check out more abbreviation information and how surveyors will score you on them at www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_faqs.htm.

  • A proposed new diagnosis coding system could cost health care providers as much as $14 billion - more than the industry paid to ready

    computer systems for the Year 2000 conversion, says a new study sponsored by the Blue Cross Blue Shield Association. The study's authors say the $14 billion figure for implementing the ICD-10 system is a conservative estimate because they didn't include DME suppliers, nursing homes and other providers unable to develop initial cost estimates.

  • A tussle over who can claims rights to the term "Visiting Nurse Association" has led two Show Me State home health agencies to court. After engaging in litigation, the VNA of St. Louis and VNA Healthcare Inc. came to an oral settlement agreement and notified the court accordingly, says the Oct. 27 decision from the Eighth Circuit U.S. Court of Appeals (No. 02-4150).

    In the agreement, VNAH agreed to change its name to VNA TIP HomeCare and include a disclaimer of any connection with VNASL. But shortly after the oral agreement was made, the parties disagreed over some of the details - particularly, when VNAH would begin and end using the disclaimer and whether the disclaimer had to be used outside of VNASL's trade area.

    VNASL sought to have the oral agreement enforced, but the U.S. District Court said the two agencies never had truly come to "a meeting of the minds" and therefore the agreement was not enforceable. The Appeals Court disagreed, and remanded the case back to the lower court with instructions to enforce the orally agreed-upon settlement.

  • Don't count on the campaign against health care fraud and abuse to ease up any time soon. In fiscal year 2003 - which ended Sept. 30 - the Department of Justice reeled in $1.7 billion in civil fraud recoveries against health care companies. Put another way, fraud settlements are costing health care organizations more than $6.5 million per business day.

    Health care fraud also represents the lion's share of the $2.1 billion in total fraud recoveries netted by the DOJ in FY 2003. That figure represents a 75 percent jump over last year's total, according to the DOJ.

  • A new OBQI tool is available on CMS' Web site. Statistics experts may want to take a look at "Appendix B" to the overview on risk adjustment procedures used for home health agencies' Outcome-Based Quality Improvement reports. The new appendix provides definitions of measures that appear in OBQI reports, "including detailed specifications for calculating these measures," CMS says at www.cms.hhs.gov/oasis/obqi.asp#risk.

  • HHAs served by regional home health intermediary Palmetto GBA may notice some payment hiccups related to remittance advices issued Nov. 7 and Nov. 10. Palmetto has corrected, or in some cases prevented, the erroneous RAs it issued on those dates, but payments will be delayed accordingly, the RHHI says in a Nov. 10 posting on its Web site.

  • For-profit hospice chain VistaCare Inc. saw revenues climb 43 percent in the latest quarter. The Scottsdale, AZ-based company reported net income of $3.8 million on revenues of $50.0 million for the quarter ended Sept. 30, compared to a $1.8 million profit on $35.1 million in revenues for the same period in 2002.

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