Home Health & Hospice Week

Government watchdog keeps close eye on home care topics.

The HHS Office of Inspector General is singing a familiar tune in its latest cost-saving suggestions, but it could be home care providers' swan song.

The OIG hits on one of its favorite targets, wheelchairs, in its 2004 Red Book. The report is a compilation of OIG cost-saving recommendations that the government hasn't fully implemented.

But for a change, the Centers for Medicare & Medicaid Services already is in the process of implementing almost all of the OIG's new home care recommendations this year. The OIG urges CMS to come up with new coding for power wheelchairs, because its review found Medicare K0011 reimbursement amounts exceeded median wheelchair prices from other payors by up to 242 percent.

Of course, CMS already has issued a proposal for new wheelchair codes (see Eli's HCW, Vol. XIII, No. 31, p. 243). But suppliers could be in for a hard time if the new codes trim as much out of wheelchair spending as the OIG expects: $224 million per year.

The OIG also urges CMS to use its inherent reasonableness authority to cut power wheelchair rates. CMS has to issue its final IR rules and policies first, it responds.

The OIG attacks power wheelchairs on other fronts as well. The watchdog urges CMS to revise durable medical equipment regional carrier wheelchair coverage policies, put more wheelchair claims under medical review, and educate ordering physicians and beneficiaries about wheelchair coverage criteria.

CMS has undertaken all of these steps in its Operation Wheeler Dealer campaign.

Step not taken: One recommendation CMS hasn't implemented is the OIG's suggestion to cut enteral nutrition payment rates with its IR authority. Medicare prices for Category I formulas are up to 115 percent over other payers' median prices, the OIG found.

Once again, CMS is waiting on its IR regs to come through before instituting cuts to any DME items.

The report is at www.oig.hhs.gov/publications/redbook.html#1. The OIG doesn't overlook home health agencies in its latest Red Book. The watchdog recommends that CMS recoup overpayments due to agencies' mistakes answering M0175, the OASIS item on patients' prior hospital stays. CMS already is preventing such overpayments with edits, and will start making retroactive recoupments in January 2005 (see Eli's HCW, Vol. XIII, No. 28, p. 219). Don't let those error messages from HAVEN keep you from using 2005 diagnosis codes. HAVEN is generating error messages when HHAs use the new ICD-9 codes, the National Association for Home Care & Hospice says. But CMS tells NAHC the OASIS and claims systems will accept the new codes, even if HAVEN generates warning messages about them. CMS will fix the problem in a future release, it told NAHC. Fee schedule amounts for the new wheelchair cushion [...]