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 OIG finished collecting data from suppliers about complex rehab and K0823 devices March 28.

Suppliers' forms "can explain to the OIG the service-intensive nature of providing power wheelchairs, including complex rehab," AAHomecare notes in a message to members. The data suppliers provide to the OIG will help "begin to quantify the service-related costs of providing the full range of power wheelchairs to Medicare beneficiaries."

AAHomecare is generating input on calculating service and overhead costs as well, the trade group notes.

• The Centers for Medicare & Medicaid Services revised its HH PPS PC Pricer again on March 27. The update was "due to provider update logic issues," CMS says in a March 31 email to providers. You can download the latest version of the new pricer online at www.cms.hhs.gov/PCPricer/05_HH.asp.

• Get ready for a new look from Medicare contractor National Government Services (formerly RHHIs United Government Services and Associated Hospital Service and DMERC Adminastar Federal). NGS will soon launch a new Web site that "will provide ease of navigation and search efficiency for the provider community," the intermediary pledges in a message to providers.

A preview of the Web site is online at www.adminastar.com/files/WebSiteListservGraphics_LMSAll.pdf.

• If you're confused about whether to use HIQH or HIQA for Common Working File history access, listen to RHHI Palmetto GBA. "HIQH contains more detailed information about Home Health Episodes than HIQA," Palmetto explains in its Frequently Asked Questions for the second quarter of fiscal year 2008.

For a copy of the 10 FAQs, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Palmetto FAQs" in the subject line.

• The OIG is joining the digital age. The agency has revamped its rules for requesting advisory opinions in an interim final rule published in the March 26 Federal Register.

The OIG will no longer ask for initial deposits and will require electronic payments, the agency notes in a statement. "We believe these regulatory changes will better reflect current electronic payment methods, will increase efficiency in processing payments from requestors and will benefit requestors by consolidating their payment obligations into one final payment," it says.

The rule is online at www.oig.hhs.gov/authorities/docs/08/73_fr_15937.pdf. More information on the advisory opinion process, under which the OIG says yea or nay to proposed business arrangements in light of kickback concerns, is at www.oig.hhs.gov/fraud/advisoryopinions.html.

• Despite worries about HHAs' future Medicare payment rates, acquisitions continue at a rapid pace. LHC Group Inc. has purchased Home Care Connections Inc. and Rivercrest Home Health Care Inc. with four locations in Amarillo, Odessa, Uvalde and San Antonio, TX.

The agencies' service areas span 64 counties in Texas, which brings LHC's total service area in Texas to 102 counties, the Lafayette, LA-based regional chain says in a release.

Almost Family Inc. will buy Home Healthcare Services in Jacksonville and Ormond Beach, FL for $16 million, the Louisville, KY-based company says in a release. In addition to a certified HHA, Apex's home care physician practice and an outpatient rehabilitation business are included in the deal.

Apex's HHA had $15.5 million in revenues last year, according to the company.

And Amedisys Inc. closed its blockbuster acquisition of TLC Health Care Services Inc. March 26, the Baton Rouge, LA-based chain says. Amedisys paid $395 in cash for the chain with more than 100 locations in 22 states and Washington, DC.

Amedisys will have 480 locations in 35 states thanks to the deal (see Eli's HCW, Vol. XVII, No. 8).