Home Health & Hospice Week

Lawmakers are facing pressure to find Medicare cuts.

A recent message about the Medicare program's viability isn't new, but it might weigh on lawmakers' minds as they negotiate a Medicare budget bill in the next few months.

The Medicare Board of Trustees says the Part A trust fund will become insolvent by 2019, according to the Trustees' report released in late March. That's the same estimate as last year.

The Trustees also issued a Medicare funding warning, which will require the next president to propose a plan to fix the problem. But President Bush's Medicare proposal this year, required by last year's warning, is going nowhere, insiders note.

"Congress appears reluctant to address the hot-button political item" of overall Medicare re-form this election year, notes the National Association for Home Care & Hospice. But lawmakers will be looking for places to make cuts to pay for a physician fix, and home care rates are still at the top of the hit list.

About 1,000 physicians flooded Capitol Hill this week to lobby their representatives to avoid the 10 percent cut to Medicare payment rates scheduled for July 1. That pressure could cause more legislators to consider home care cuts as a way to fund the physician fix, industry veterans worry. • Another prospective payment system claims problem has been corrected. Low utilization payment adjustment (LUPA) claims were receiving reason code E46#U because the Fiscal Intermediary Shared System wasn't assigning value codes properly for the LUPA add-on, explains regional home health intermediary Cahaba GBA on its Web site.

A system update made March 10 resolved the problem and held claims released and continued processing, Cahaba explains.

Another claims system snafu might require some work on your part. Claims received on March 25 were incorrectly returned to provider (RTP'd) with reason code 32103 or 32104, Cahaba says. The intermediary moved claims out of the RTP file to continue processing the next day, but the system auto-canceled some requests for anticipated payment (RAP) because the claims were RTP'd and didn't make the required timeframe. In those cases, agencies would see the final claims move back to the RTP file with reason code 38107 because the system couldn't find a matching RAP, the RHHI explains.

Do this: "If you have claims in RTP with reason code 38107, resubmit the RAP for processing," Cahaba instructs. "Please ensure the information on your resubmitted RAP is identical to the originally billed and auto canceled RAP to avoid billing errors for overlapping episodes. After the RAP is processed, you may F9 the claim from the RTP file." • The HHS Office of Inspector General is one step closer to issuing a report on complex rehab power mobility devices, according to the American Association for Homecare. The [...]