Home Health & Hospice Week

Keeping tabs on your outlier percentage under the new 10 percent cap just got easier. The Fiscal Intermediary Shared System will now show you your outlier payment and home health prospective payment system totals, regional home health intermediary Cahaba GBA notes on its Web site.

How to do it: Just use the new FISS screen created for the process, says RHHI Palmetto GBA. "Access the information by selecting Option 01 (Inquiries) from the DDE Main Menu and option 67 (Home Health Payment Totals Inquiry) from the submenu," the contractor instructs home health agencies on its Web site. "Providers will be required to enter their OSCAR (Provider number) and National Provider Identifier (NPI) to access this information."

The Centers for Medicare & Medicaid

Services had made the screen available earlier this year, but it wasn't functioning properly (see Eli's HCW, Vol. XIX, No. 11, p. 86).

Another outlier glitch: "Until recently ... FISS was not withholding any outlier payments and was not limiting the outlier payments to 10 percent of the HH PPS payment," Palmetto adds. "This has caused providers to have outlier payments in excess of the 10 percent limitation. The system issue has been corrected and the outlier payment limitation is now being applied correctly."

For those HHAs who have outlier payments totaling more than 10 percent of their total PPS payments, Medicare will stop paying them outlier amounts until their PPS payments rise enough to putthe outliers under the 10 percent cap, Palmetto explains.

Don't worry that quarterly outlier reconciliation will take outlier payments back, the contractor adds. That process is for Medicare to pay out outlier payments, not take them back in.

• If a new bill already approved by the Senate moves forward, you could have another eight months before the exceptions process for Part B therapy caps expires. The legislation would also postpone the 21.2 percent pay cut for physicians until Oct. 1.

On March 10, the Senate approved the American Workers, State, and Business Relief Act of 2010 (H.R. 4213), which includes an extension of the cap exceptions process that is currently set to expire April 1.

The bill also includes federal Medicaid funding assistance, notes the National Association for Home Care & Hospice. The fate of the bill is unclear, however. The House may not be receptive to passing the bill and physician advocacy organizations still aim for a more permanent fix to the payment formula rather than repeated last-minute votes to avert cuts year after year. "These band-aid fixes have only served to increase the size of the cuts and the cost of reform,"

American Medical Association president J. James Rohack says in a statement.

• When you're evaluating patients for fall risks, raise a red flag if they mention being on a sedative hypnotic drug. A recent study published in The American Journal of Managed Care revealed that patients receiving sedative hypnotics classified as Beers high-severity (BHS) were 22 percent more likely to suffer a fall or fracture than control subjects, according to a release.

Sedative hypnotic drugs slow down the body's functions, and physicians often prescribe them to treat anxiety or promote sleep. A couple well-known sedative hypnotics include diazepam (Valium) and secobarbital (Seconal). In addition, patients exposed to these medications had significantly higher adjusted medical and total health care costs than those in the control group, according to the study in the January issue of the journal. This study was the first to examine clinical outcomes associated with specific so-called potentially inappropriate medications (PIMs) and is based on electronic pharmacy and medical claims data, the release says.

"These findings demonstrate that elderly patients who take certain PIMs are at increased risk of adverse events and higher health care costs," said pharmacist Karen Stockl of Prescription Solutions and lead author of the study.

• Your ratio of patients with private insurance as their payor may be on the rise. More than eight million Americans have purchased longterm care insurance, reports the American Associationfor Long-Term Care Insurance.

Medicare pays for 37 percent of home care expenditures, AALTC says. About 42 percent of individuals who currently receive long-term care insurance benefits get their care at home, the trade group notes. The per hour average cost of a home health aide has increased 2.5 percent since last year, AALTC adds. The national average hourly cost for an aide is $20.25, the group says in a new report.

• Watch out, you may be listing the wrong physician number on your hospice notices of election (NOEs). For NOEs effective Jan. 1 or later, hospices "shall enter the NPI and name of the attending physician designated by the patient at the time of election as having the most significant role in the determination and delivery of the patient's medical care," RHHI Palmetto GBA explains in a new question and answer on its Web site.

Before the new rule announced in Change Request 6540, hospices could list the NPI of the doc responsible for certifying the terminal illness and signing the hospice plan of care, Palmetto says in the Q&A.

• If you serve patients affected by flooding in North Dakota, you may be eligible for some regulatory relief. The Department of Health and Human Services issued a public health emergency and regulatory waiver March 20 that is retroactive to Feb. 26.

• You may need to tweak your procedures to keep track of claims if Cahaba GBA is your intermediary. On its new claims audit trail report, Cahaba will no longer include the 14-digit "CLAIM-NBR" that Cahaba assigns when it receives the claim, the intermediary says in a message to providers. That's because the number is useless once the claim moves into FISS. The change will take place April 20. Once the ANSI 5010 format takes effect, "the current 'Claims Audit Trail Report' will be replaced with a 277CA claim acknowledgement transaction that will include the DCN assigned by FISS," Cahaba adds.

• Home Care Rochester (of New York) will buy the Genesee County Department of Health's certified HHA, reports Buffalo Business First. HCR, owned by L. Woerner Inc., last year took  over Orleans County's HHA, the newspaper says.

In Marshall, Minn., Avera Home Health Care will be closing its doors after the city declined to buy back the HHA from Avera Marshall Regional Medical Center, reports the Independent.

The hospital decided to shutter the program, which was losing money, after the city sold the hospital to Avera, the newspaper notes.

The agency, which has 16 employees and up to 50 patients, lost nearly $200,000 last year, the Independent says.

• The fraud convictions just keep coming in South Florida. Two owners of Miami-area durable medical equipment businesses were convicted of health care fraud recently, notes the U.S. Attorney for Southern Florida Jeffrey Sloman. A jury found that Yasmanny Benavides used Lacary Medical Services Equipment Inc. and Lily Orthopedic Inc. to bill Medicare for nearly $20 million in DME that was not prescribed by doctor or provided as claimed, Sloman says in a release.

And after a six-day trial, another jury found Maria A. Aloise guilty of ten counts of health care fraud. Aloise, who was president and owner of Atenas Medical Equipment Inc., billed Medicare for $1.4 million in DME with forged prescriptions, certificates of medical necessity, and delivery receipts, Sloman says in a separate release. Aloise also fraudulently used identifying information of numerous Medicare beneficiaries and physicians.

And a new home health agency scam has been busted. Juan Blandy, owner of Supreme Home Health Care Agency, recently was arrested by the state's Medicaid Fraud Control Unit and Miami-Dade Police, reports the Miami Herald.

Investigators say Blandy paid thousands of dollars in illegal kickbacks to several case managers employed by Medicaid-enrolled agencies in exchange for their referrals of Medicaid recipients to his company, the newspaper reports. Blandy never actually furnished services to the patients and billed Medicaid for $76,000. The Medicaid case managers accused of receiving kickbacks were arrested and are on probation, the Herald adds.