Home Health & Hospice Week

Got a PPS question? You might find your answer online.

The government and its contractors are trying to lend you a helping hand during the transition to PPS changes this month.

The Centers for Medicare & Medicaid Services has issued a brief four-page guide for home health agencies that want to explain the prospective payment system, including its changes in 2008, to beneficiaries. The guide also explains patients' eligibility requirements for home care and billing for durable medical equipment in competitive bidding areas, which will expand to 70 cities shortly.

The brief document might also be good for educating your own sales and marketing staff or referral sources, observers suggest. The guide released Jan. 8 is at www.cms.hhs.gov/MLNProducts/downloads/HomeHlthProspPymtfctsht08-508.pdf.

And regional home health intermediary Cahaba GBA has posted a wealth of PPS information on its Web site. Cahaba's education documents include government documents, slides from Cahaba's recent conference reviewing the changes, and frequently asked questions about the refinements.

Example: HHAs should use revenue code 027X or 0623 on their final claim when furnishing non-routine supplies (NRS), Cahaba explains. Informational edits for those line items will begin in April.

Those materials are at https://www.cahabagba.com/part_a/education_and_outreach/educational_materials/hha_refine_pps.htm.

• You'll have to use National Provider Identifiers in claim secondary fields starting in May, CMS reminds in a recent message to providers.

"For Medicare purposes, this means that submission of an NPI for an ordering/referring provider is mandatory effective May 23, 2008," CMS explains in a recently revised MLN Matters article (MM5674). "Legacy numbers cannot be reported on any claims sent to Medicare on or after May 23, 2008."

And saying your referring docs won't provide you with their numbers won't cut it with CMS. "It is the responsibility of the claim/bill submitter to obtain the ordering/referring/attending/... NPI for health care providers," the agency instructs in the article.

Warning: In fact, home care providers should obtain referring physicians' NPIs before furnishing services, CMS advises. Medicare won't permit doctors who haven't gotten their NPI by May to order services for beneficiaries.

• Hospice providers could face denials if CMS doesn't change the implementation date of an important transmittal. In December, the National Association for Home Care & Hospice requested clarification from the agency on Change Request 5550, which eliminated stamped and electronic signatures for hospice certifications, effective Sept. 3, 2007.

Many hospices are unaware of the new restrictions--or confused about CMS' intent, NAHC told the agency in a recent letter. At least one intermediary, Cahaba GBA, has notified hospices that it will deny claims based on failure to adhere to the new signature requirements. To see CR 5550, go online to www.cms.hhs.gov/transmittalsdownloads/R220PI.pdf.

• Don't expect to call National Government Services and get your claim canceled or returned to provider (RTP'd). As of Jan. 11, NGS will no longer cancel or RTP claims at the provider's request, says the intermediary that was formerly Associated Hospital Service and United Government Service. Providers will have to wait for the claim to finalize, then correct or cancel the claim themselves, NGS instructs in a Jan. 8 message to providers.

• Amedisys Inc. has made acquisitions in three certificate of need areas for undisclosed terms. The Baton Rouge, LA-based chain acquired six home health agencies in Georgia and South Carolina from Memorial Health University Medical Center of Savannah, GA, the company says in a release.

The HHAs have coverage in 32 counties in Southeast Georgia and will generate about $10 million in revenue this year, Amedisys expects.

And the company bought an HHA in Carolina, Puerto Rico. The unnamed HHA, which marks Amedisys' first purchase in the territory, should generate less than $1 million in 2008, the company says.

• The controversial sale of National Home Health Care Corp. to Angelo Gordon & Co. and Eureka Capital Partners finally closed. Angelo Gordon could pay as much as $65 million for the Scarsdale, NY-based company, depending on the earnings it generates, reports The Daily Deal newspaper.

Minority shareholders originally protested that the sale to Angelo Gordon was corrupt and filed a lawsuit, only approving the sale once the investment firm sweetened its buyout offer last summer (see Eli's HCW, Vol. XVI, No. 21).

• LHC Group Inc. is entering a new market and solidifying its presence in another with two recent acquisitions. The Lafayette, LA-based chain made its first foray into the Missouri market with the purchase of Access Home Health Agency Inc. in Springfield. The agency generates about $2.9 million in revenues annually and serves 20 counties, LHC says in a release.

LHC has also entered into a partnership agreement with Marshall Medical Centers in Alabama to furnish home care services in Guntersville and the surrounding areas. The acquisition adds two more counties to LHC's service area in the state to total 41, LHC says.

• RHHI Palmetto GBA has revised its Local Coverage Determinations for Home Health Occupational Therapy (L12643), Home Health Psychiatric Care (L265) and Home Health Speech Language Pathology (L7002). The changes, which include code additions, became effective Jan. 4, Palmetto says. You can view LCDs at www.cms.hhs.gov/mcd/overview.asp.