Industry Notes:
USE NEW DIAGNOSIS CODES ON THE DOT NEXT MONTH
Published on Thu Sep 23, 2004
ICD-9 updates among HHA changes on tap for Oct. 1. This is a year of firsts for home health agencies.
2004 is the first year HHAs and other providers will have no grace period for implementing new diagnosis codes. Unlike in previous years, agencies will have to start using the new ICD-9 codes and stop using the old ones on Oct. 1 on the dot (see Eli's HCW, Vol. XIII, No. 20, p. 154). Providers used to have until Jan. 1 to make the transition, until HIPAA prohibited the grace period.
This year is also the first that HHAs' reimbursement update isn't regularly scheduled for the start of the federal fiscal year, Oct. 1. Instead, the Medicare Modernization Act permanently pushed back the home health payment update until Jan. 1 (see Eli's HCW, Vol. XIII, No. 21, p. 162). However, hospice payment rates remain on the FY schedule.
And new hospital diagnosis-related groups that are subject to proration if the patient is discharged to home health take effect next month (see Eli's HCW, Vol. XIII, No. 22, p. 174).
Medicare reimbursement rates for inhalation and other drugs under Part B are still up in the air. The Centers for Medicare & Medicaid Services will base the 2005 drug payments on 106 percent of the "average sales price" for the third quarter of 2004. CMS won't have that ASP data until early December, and it'll be a scramble to translate the data into HCPCS codes in time for Jan. 1, 2005, CMS said at the recent Practicing Physicians Advisory Council meeting.
The final physician fee schedule rule containing drug prices will be based on second quarter 2004 data, which CMS just received. CMS will release this final rule in November, and officials have referred to it as the second of its "dry runs" for figuring out how to translate raw drug data into prices.
Respiratory and DME company Rotech Healthcare Inc. continues to cast doubt on its ability to furnish Medicare inhalation drugs if the 89 percent cut to them goes through as proposed (see Eli's HCW, Vol. XIII, No. 28, p. 219).
Orlando, FL-based Rotech is waiting to see "whether CMS will increase fees for services associated with dispensing such drugs" and if the cut really will reach the staggering amount. The answers to these questions "will determine whether or not it is economically feasible for the company to continue to provide inhalation drugs in 2005," Rotech says in a release.
Physicians at PPAC meeting pleaded with CMS to provide drug prices as soon as possible. "I'm going to have two months to decide which office I'm going to close, which employees I'm going to lay off, what services I'm going to provide," said one doctor.
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