Home Health & Hospice Week

But timeline for correcting improperly paid claims unclear.

If you serve patients in a rural county using a blended MSA-CBSA code this year, you should finally be receiving the 5 percent rural add-on you're entitled to.

The Centers for Medicare & Medicaid Services has added the blended wage index codes to the list of county codes eligible for the add-on, CMS says in March 10 Transmittal No. 887. There are 63 codes in 22 states that CMS originally left off the add-on eligibility list because they didn't start with "999" (see Eli's HCW, Vol. XV, No. 9).

The change was put into the Medicare claims processing system by March 13, the transmittal says. Intermediaries were supposed to start processing claims with the new add-on list after the installation.
 Intermediaries will go back and adjust the claims they paid improperly due to the code confusion, CMS instructs. The agency specifies no timeline for making the adjustments.

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R887CP.pdf.

• The U.S. Senate March 16 passed the budget resolution that includes no cuts to Medicare, Medicaid or other entitlement spending programs. The Senate Budget Committee approved the budget blueprint March 9 (see Eli's HCW, Vol. XV, No. 11).

The Senate narrowly rejected an amendment from Sen. John Cornyn (R-TX) that called for $10 billion in cuts over five years for programs overseen by the Senate Finance Committee, such as Medicare.

• CMS isn't providing enough information on Program Safety Contractors in its PSC evaluation reports, the HHS Office of Inspector General blasts in a recent report on the contractors. The reports "contained minimal information about [PSC] achievements related to detecting and deterring fraud and abuse under benefit integrity task orders," the OIG criticizes.

The OIG wants CMS to include quantitative information about PSCs' fraud and abuse detection and deterrence activities in the reports. But CMS argues that including such information "may compromise investigations and create perverse incentives."

The report is at http://oig.hhs.gov/oei/reports/oei-03-04-00050.pdf.

• Home care providers can expect another wave of confusion over the Part D drug benefit from patients who are being passively enrolled in drug plans.

"CMS is facilitating the enrollment of certain beneficiaries into prescription drug plans," the agency says in a release. CMS has begun mailing letters to 1.2 million people with limited income and resources who are enrolled in other federal assistance programs such as Supplemental Security Income and Medicare Savings Programs, as well as beneficiaries who have applied for and been approved for a low-income subsidy for the Part D benefit.

"The letters let the beneficiary know in which Medicare prescription drug plan they will be enrolled by CMS if they take no action before April 30," the agency says. Unless they enroll on their own during March, these beneficiaries will have their prescription drug coverage begin on May 1.

"CMS is enrolling these beneficiaries earlier to make sure that they receive the benefit of the extra help immediately, and without having to pay a penalty," CMS maintains. "These beneficiaries can still decline the enrollment before it becomes effective."

CMS first passively enrolled beneficiaries when the Part D benefit began in January (see Eli's HCW, Vol. XV, No. 2).

• CMS has posted new information to help providers understand, obtain and use their new National Provider Identifier (NPI) numbers by the upcoming May 23, 2007 compliance deadline. New application guidelines for providers who wish to obtain an NPI through the Electronic File Interchange ("bulk enumeration") process are now available at www.cms.hhs.gov/NationalProvIdentStand/07--efi.asp.

Under the EFI process, providers and provider groups can have a separate EFI organization apply for an NPI on their behalf. The EFI organization submits the provider's application with other applications as part of an electronic file to streamline processing and reduce the administrative burden on CMS and the provider community.

• Home care outcomes are giving some states' providers a bad rap. The HHS Agency for Healthcare Research and Quality has released a state-by-state quality measure comparison tool at www.qualitytools.ahrq.gov/qualityreport/2005/state. It compares home health quality measures, among many items. One of the options reviews a state's strongest and weakest measures, including home health standards.

The outcomes tool, which draws information from Home Health Compare, is already getting attention in the mainstream press. The Milwaukee Journal Sentinel and the Rochester, MN Post-Bulletin have run articles highlighting their respective state's poor home care performance measures.

• The HHS Office of the Assistant Secretary for Planning and Evaluation is getting ready to scrutinize fall prevention. ASPE "is planning to conduct a demonstration and evaluation of a multi-factorial fall prevention program," HHS says in a March 17 Federal Register notice. The demo aims to measure the prevention program's impact on health outcomes for the elderly, "as well as acute and long-term care use and cost."

The demo will study individuals with private long-term care insurance who are age 75 and over, HHS says in the notice. "The project will provide information to advance Departmental goals of reducing injury and improving the use of preventive services to positively impact Medicare use and spending."

• Almost Family Inc. saw earnings rise in the latest quarter. The Louisville, KY-based home health chain, which shed its day care business last fall, reported net income of $859,425 on revenues of $19.4 million for the quarter ended Dec. 31, 2005, compared to a $362,994 profit on revenues of $16.9 million for the same period in 2004. Revenues for its Caretenders visiting nurse unit rose from $8.2 million to $10.6 million in the quarter.

The company is "a pure-play home health platform with a strengthened and reorganized management team, improved operating and information system infrastructure and a robust acquisition pipeline," CEO William Yarmuth says in a release.

• Sunny Alfred Imeh has been sentenced in Houston federal court for his role in a "motorized wheelchair scam," U.S. Attorney Chuck Rosenberg says in a release. Imeh will serve 63 months in federal prison, without parole.

Imeh pled guilty last June to one count of conspiracy and one count of health care fraud for his role in fraudulently billing Medicare and Medicaid for almost $5 million through his Houston-based DME company, Transcon Medical Services Inc., Rosenberg says.

When Transcon billed Medicare and Medicaid for providing beneficiaries with motorized wheelchairs, wheelchair accessories and alternating pressure mattresses, Imeh allegedly either provided beneficiaries no equipment at all or provided less expensive or used equipment, such as scooters and regular mattresses.