Home Health & Hospice Week
Senators Criticize Medicare Appeals Changes
ALJ changes could restrict access to appeals avenue, top lawmakers say. The plan to shift the administrative law judges from the Social Security Administration to the Department of Health and Human Services has serious problems that could prevent you from receiving a fair shake in appealing your denied claims, Sens. Charles Grassley (R-IA) and Max Baucus (D-MT) warn in a letter to the SSA and HHS secretaries.
The transfer will begin in July and be complete by October (see Eli's HCW, Vol. XIV, No. 10, p. 74).
The problems: HHS plans only three field offices plus a headquarters for the whole nation - not enough locations to provide meaningful access to ALJs. That means ALJs will hear most cases via video conferencing, but HHS doesn't seem to be up to providing video conferencing facilities, the Senators worry.
The field offices still lack staff, and some ALJs will be forced to take on management-related tasks that could distract from their appeals-related responsibilities. Some of the new ALJs may be totally untrained, and the "nuts and bolts" issues of running the new offices remain unsettled, the letter charges.
The three-year project in Florida is available to fee-for-service Medicare beneficiaries with advanced-stage illnesses including congestive heart failure, diabetes or coronary heart disease. Disease management organization LifeMasters will enroll up to 30,000 Flor-ida beneficiaries for the demo.
You could run into problems billing for these patients, however. Because the demonstration has an HMO plan number (H5413) for the DM payments to LifeMasters, intermediaries and carriers may mistakenly apply managed care rules to all claims for them. "No referrals for care are needed and all Fee-For-Service claims will be processed under traditional Medicare payment rules," CMS stresses in the article.
"It is simply unfair to reimburse these providers any less than what they currently receive," U.S. Rep. Mike Ross (D-AR) told AP. Without home care, many patients will end up in costlier institutional settings, noted Rep. Vic Snyder (D-AR), who is a physician.
CIGNA HealthCare's Medicare Web site has launched a new feature called "M.D. Corner." Created by Medical Director Dr. Robert Hoover, M.D. Corner aims to provide DMEPOS information relevant to both practicing physicians and the supplier community. The feature is accessible from the main CIGNA Medicare Web site page at www.cignamedicare.com, and it in-cludes a feedback link for suggesting new topics.
Dallas-based Tenet, which agreed to sell 11 HHAs to Amedisys Inc. earlier this year, now has one remaining HHA, one infusion center and two hospices. None are for sale, the Journal says.
The net proceeds on the sales after tax were about $6 million, Tenet says.
Heritage owns and operates Heritage Brookside Home Care and Horizon Home Health serving more than 5,000 patients annually. The units will keep their names and current leadership after the sale, Gentiva says.
Those convictions bring to 20 the total number of people convicted in connection with a scheme in which providers fraudulently billed Medicare and private insurance companies for medical services, equipment, medications and physical therapy that were either not provided or were medically unnecessary.
People connected with the scam allegedly recruited beneficiaries in the Vietnamese and Korean communities with promises of free "milk" - meaning enteral nutrition - and motorized wheelchairs.
Home Health & Hospice Week
- Medical Review:
RACs Could Drive Home Care Providers Out Of Business
Contractors have huge incentive to recoup. Recovery Audit Contractors could be more than just a [...] - Audits:
RAC Home Health Hit List Likely To Include Therapy
Pilot's medical review focus could spill over to other regions. The most confusing areas of [...] - Reimbursement:
Brace Yourself for Lower Oxygen Rates
CMS plans to lower Medicare reimbursement as of April 8. Oxygen suppliers who were holding [...] - Hospice:
Kick Hospice Consult Kickbacks To The Curb
CMS issues instructions on hospice pre-election evaluation and counseling services. If your hospice medical director [...] - Compliance:
Avoid Medical Director Kickbacks With These 4 Tips
Documenting your medical director's service is a must. Your hospice medical director arrangements could be [...] - Lawsuits:
DME Suppliers Win Case For CMN Primacy
HHS loses suit but sets payback amount. A recent court case offers good news and [...] - Industry Notes:
Senators Criticize Medicare Appeals Changes
ALJ changes could restrict access to appeals avenue, top lawmakers say. The plan to shift [...]
