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Home Health & Hospice Week

Industry Notes:

Straighten Out Your Payment Diagnosis Code Questions With New Instructions

Published on Thu Jan 22, 2004

M0245 codes won't show up on the claim, manual revisions explain.

Months after M0245 was introduced, the new OASIS item continues to cause billing confusion among home health agencies.

But a new transmittal from the Centers for Medicare & Medicaid Services may clear up questions and ensure HHAs get their rightful payment under the prospective payment system.

HHAs must follow ICD-9 coding conventions when assigning a patient's primary diagnosis, thanks to the Health Insurance Portability and Accountability Act (HIPAA).

And the primary diagnosis must match on both OASIS and the claim submitted to Medicare, according to Jan. 16 Transmittal No. 61 - a revision to the Internet Only Manual (IOM) on Medicare Claims Processing (Pub. 100-04). IOMs replaced the HIM 11 last fall.

But there is no such matching requirement for the diagnosis codes that go into M0245, CMS notes. "The codes reported in M0245a and M0245b may not appear on the claim form at all," explains the transmittal at http://cms.hhs.gov/manuals/pm_trans/R61CP.pdf.

CMS added M0245 to OASIS when HIPAA required agencies to report a non-paying diagnosis V code in M0230, bumping a payment diagnosis code. HHAs can put that bumped payment diagnosis code in M0245 and still capture the associated reimbursement for the condition (see Eli's HCW, Vol. XII, No. 13, p. 101).

  • Home care was one of the areas with greatest spending increases in 2002, according to the Maryland Health Care Commission. Home care spending for Maryland residents increased 20 percent over the previous year, the Associated Press reports. Health care spending for residents overall grew 11 percent in the time period.

  • For-profit hospice chain Odyssey Health-Care Inc. has made the largest acquisition in its history. The Dallas-based publicly traded company acquired Crown of Texas Hospice, Amarillo, Ltd. and Crown of Texas Hospice, Southeast, Ltd. effective Jan. 15. The Crown hospices serve about 400 patients in 29 counties in the Texas panhandle and north of Houston, Odyssey says in a release.

    Odyssey paid $22.5 million in cash for the hospices, which will continue to operate as separate programs from other company locations in the state. "While this acquisition is the largest in our history, our focus will remain on organic growth,"

    Odyssey President and CEO David Gasmire says in the release.

    The acquisition brings Odyssey up to 68 locations in 29 states. Odyssey currently is the largest publicly traded hospice company, although an initial public offering from VITAS Healthcare Corp. after its sale may change Odyssey's status (see Eli's HCW, Vol. XIII, No. 1, p. 5).

  • Operation Wheeler Dealer is taking its toll on the biggest as well as the smallest suppliers. The Scooter Store in New Braunfels, TX is cutting 200 jobs thanks to the recent "clarification" on wheelchair and scooter coverage from Medicare (see story, p. 19).

    "While it is very painful for us to let any of our employees go, we are equally distressed that America's disabled may be denied the mobility assistance that provides freedom, independence and dignity to their lives," The Scooter Store's Margaret McGuckin told the San Antonio Express-News.

  • Increased demand for private-pay home care has been good to Havertown, PA-based Visiting Angels. The custodial care franchisor has sold and opened 70 franchise locations in 2003, totaling 170 locations in more than 40 states, the company says in a release.

  • Option Care Inc.'s foray into the St. Louis, MO market appears to have paid off. The Buffalo Grove, IL-based infusion company is moving and tripling the size of its office in the city. The change is due to dramatic growth since introducing its services to the St. Louis market three years ago, the company says.

  • The parents of a two-year-old who died after allegedly receiving incorrect total parenteral nutrition in the home are planning to sue Baltimore's Johns Hopkins Hospital and its home care program over the mistake, AP reports.

    Mark and Mindell Cohen, the parents of Brianna Cohen who died Dec. 4, sent a notice Jan. 13 to the state's health claims arbitration office - the first step in bringing a malpractice lawsuit.

    Brianna, a cancer patient, allegedly died as a result of receiving TPN with potassium levels four to five times higher than called for, AP says. Johns Hopkins says miscommunication between the hospital and one of its pharmacies may have been a contributing factor to the error. The hospital says it has switched preparation of all home care TPN solutions to fully automated systems previously used only for inpatients.

  • Are home care kickbacks and illegal patient steering rife in Sin City? That's what investigators intend to find out, according to the Las Vegas Business Press.

    CMS, the Nevada Attorney General, and individual hospitals all are investigating allegations that doctors and discharge planners are furnished with kickbacks ranging from golf games to vacations to cash to steer patients to certain home care agencies, the paper claims. Anonymous sources said they are losing up to 50 percent of their business to unethical home care operators in the area.

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