Home Health & Hospice Week

Lawmakers will be looking for Medicare cuts--and home care is a juicy target.

Home care providers have another reason to fear for their 2008 reimbursement rates.

On one hand: Both the Senate and House budget resolutions reject home care cuts proposed by President Bush in his 2008 budget, notes the American Association for Homecare (see Eli's HCW, Vol. XVI, No. 6).

On the other hand: The resolutions call for at least $15 billion and up to $50 billion to reauthorize the State Children's Health Insurance Program (SCHIP). And they establish reserve funds to fix the 10 percent cut to physician payments next year. The Senate resolution specifically calls for $15 billion to come from Medicare provider payment cuts over five years.

The resolutions "could result in the adoption of severe cuts in Medicare provider payments to offset new SCHIP costs and the physician fix," warns the National Association for Home Care & Hospice. The Senate Finance and House Ways & Means committees "will grapple with finding offsets later in the year," NAHC explains.

The Senate passed its resolution March 23. At press time the House was expected to pass its resolution, which the House Budget Committee already had approved, by the end of March. • Home health agencies may see more scrutiny of their OASIS and therapy practices. In March 8 testimony before the House Ways & Means Committee, HHS Inspector General Daniel Levinson reiterated his concern about the accuracy of payments to home health agencies.

The HHS Office of Inspector General will "review the extent to which Medicare HHAs accurately coded information on the assessment form that is used to determine payment rates," Levinson told the committee. The OIG will also determine whether HHA therapy rehabilitation services are medically necessary and are provided by the appropriate staff, he said.

• Be prepared to defend your claims for hypertension and organic brain syndrome. Regional home health intermediary Cahaba GBA has launched reviews of both types of claims. Widespread review 5THDO will target home health agency claims with a primary diagnosis of 401.9 (Essential hypertension, unspecified) and a length of stay greater than 120 days, Cahaba says. The review resulted from previous data analysis on such claims.

Widespread probe 5TPAI will target hospice claims with 294.8 (Organic brain syndrome) as the diagnosis code and a length of stay greater than 240 days, Cahaba says on its Web site. The intermediary will post results of the probe when it's completed.  • The fast approaching National Provider Identifier implementation won't affect your OASIS.

There will be no changes to the OASIS assessment form's space for your six digit provider number when the May 23 NPI date arrives, says billing expert Melinda Gaboury with Nashville, TN-based Healthcare Provider Solutions. So you will [...]