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 continue to put your agency's Medicare provider number in M0010 and the physician's UPIN in M0072, she tells Eli.

• Home care providers will now have to deal with medically unlikely edits (MUEs) from Medicare. Durable medical equipment Medicare Administrative Contractors (DME MACs) and regional home health intermediaries will be affected by the new round of edits, the Centers for Medicare & Medicaid Services says in a new Medlearn Matters article (5495).

"An MUE is defined as an edit that tests claim lines for the same beneficiary, Health Care Common Procedure Code System (HCPCS) code, date of service, and billing provider against a criteria number of units of service," CMS explains in March 9 Transmittal No. 1202 (CR 5495). DME MACs will deny the affected claim line under an MUE, while RHHIs will return to provider (RTP) the claim but pay other services on the claim that aren't affected by the edit, CMS says.

The MLN Matters article is online at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5495.pdf. The transmittal is online at www.cms.hhs.gov/Transmittals/downloads/R1202CP.pdf.

• You can give your two cents on two new local coverage decisions from RHHI Palmetto GBA. 

The comment period for the revised Hospice Renal Care LCD ends April 30, Palmetto says. The comment period for the Home Health Surface Electrical Stimulation in the Treatment of Dysphagia LCD also ends April 30.

You can find the LCDs online at www.cms.hhs.gov/mcd/search.asp.

• Physical therapists who practice in areas with health care provider shortages could be eligible for student loan debt relief, according to a press release from the American Physical Therapy Association.

Reps. Marion Berry (D-AR) and Jo Ann Emerson (R-MO) led a bipartisan group of representatives in sponsoring the Physical Therapist Student Loan Repayment Eligibility Act (H.R. 1134). The bill proposes to make PTs who practice in areas with a shortage of health professionals eligible for student loan repayment assistance under the National Health Service Corps Loan Repayment Program.

• California must review its Medicaid home health agency payment rates for 2001 through 2005, but that doesn't mean Golden State HHAs will see higher rates. A state appeals court has ordered a lower court to require the Department of Health Services to conduct MediCal HHA rate reviews for those years. Previously, the lower court required a review only for 2005, according to a March 15 decision in the case brought against the state by the trade group California Association for Health Services at Home (C051294).

But the court won't require the state to raise rates, just review them, the decision notes. That fact that the state repealed its requirement to review rates after the time period is irrelevant, the Court added in the decision at www.courtinfo.ca.gov/opinions/documents/C051294.PDF.

• An attorney's plan to pull the wool over the eyes of CMS in a case of DME fraud has landed him with an obligation to pay $103,000 in restitution, a jail sentence of 10 years or more and a fine as steep as $250,000.

From October 2002 through August 2004, defendant Benjamin Metsch and an unnamed co-conspirator prepared fraudulent sales documents, including stock transfer agreements, of Medicare-certified durable medical equipment companies, says a news release from U.S. Attorney for the Southern District of Florida R. Alexander Acosta.

The scam involved selling more than 67 DME companies to "straw" purchasers for sales prices that understated the companies' true value. The scammers' aim: to conceal the identity of individuals who maintained control of the companies so that those individuals could submit fraudulent Medicare claims with more immunity to Medicare contractors' oversight. Metsch's sentence is scheduled for May 18, the release says.