Home Health & Hospice Week
Watch Out For OIG Compliance Hot Spots
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.
CMS promises the rates, which are in effect for cushions furnished from July 1 through Dec. 31 of this year, are not permanent. "The 2005 fee schedule amounts for most, if not all, of the codes will be different than the current 2004 fee schedule amounts," CMS says on its Web site. For 2005 rates, the DMERCs will recalculate the fee schedule amounts using retail prices for products classified under codes K0650 thru K0668 by the SADMERC as of Oct. 31, 2004. "It is expected that most wheelchair cushion products will have received coding verifications at that point," CMS explains.
The codes, their reimbursement rates and a set of questions and answers are at www.cms.hhs.gov/suppliers/dmepos/2004WCFeesched.asp.
People are waiting in line for hours on end to attend the few remaining flu shot clinics, and public health officials urge citizens not in the high-risk population outlined by the Centers for Disease Control and Prevention to forego the shots.
The CDC and vaccine manufacturer Aventis Pasteur announced Oct. 12 a plan to get 22.4 million doses of vaccine to "high priority vaccine providers" such as hospitals, nursing homes and child care providers in the next eight weeks. After that, the remaining 8.2 million doses will go to "high-need areas."
Information about the vaccine shortage, as well as common sense steps for flu prevention like washing hands and using tissues, are at www.cdc.gov/flu/protect/vaccineshortage.htm.
Cherokee Home Health Care, which was licensed in 1970 and serving 140 patients at survey time in the end of September, had deficient accounting practices and patient notifications, the paper says. The HHA's checks to employees were bouncing and the agency should have told patients it didn't have the resources to serve them, the surveyors decided.
Cherokee's patients have been referred to other providers in the area. A complaint sparked the survey, although it was time for the agency's annual survey anyway, a survey official told the Telegraph.
The creditors will sink $38 million in cash into Coram and assume $18 million in Internal Revenue Service debt under the plan, the paper says. Pre-petition shareholders will get $40 million as part of the deal.
This plan may not be the end of the legal maneuvering, however. Shareholders can still sue the noteholders, and lawsuits against Coram executives and other parties aren't barred by the plan.
Home Health & Hospice Week
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Watch Out For OIG Compliance Hot Spots
Government watchdog keeps close eye on home care topics.
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