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Home Health & Hospice Week

Industry Notes:

Your HIPAA Clock Is Ticking

Published on Thu Mar 11, 2004

It's not quite sink or swim time, but it's getting close.

If you're not submitting electronic claims in compliance with the Health Information Portability and Accountability Act, then you'll likely be waiting quite a bit longer to get paid, says a Feb. 27 program transmittal (change request 2981) from the Centers for Medicare & Medicaid Services.

CMS will tweak its HIPAA contingency plan to push providers to get in line "as soon as possible," the transmittal says. Effective July 1 - with an implementation date of July 6 - all claims received in pre-HIPAA format will be waiting at least 27 days for reimbursement, while those claims in compliance will be eligible for payment in half that time.

The volume of Medicare electronic claims received in correct HIPAA format was up to 66.72 percent between Feb 9. and Feb.13, CMS reports. That's up from 57.6 percent the previous month.

The contingency plan is at www.cms.hhs.gov/manuals/pm_trans/R114CP.pdf.

  • You can check out your newest patient outcomes comparison on Medicare's Home Health Compare Web site at www.medicare.gov. The new numbers, which were posted in the first week of March, are calculated based on data from December 2002 through November 2003. CMS plans to update the quality data quarterly.

  • Suppliers served by durable medical equipment regional carrier CIGNA HealthCare Medicare Administration can find out more about medical review by signing up for a new "Net-Course" - an online education session - at www.cignamedicare.com/dmerc/index.html (go to "Education" and choose "NetCourses" from the pull-down menu).

    CIGNA currently offers a course on Group 2 support surfaces, and plans to add sessions on power mobility, enteral nutrition, progressive corrective action plans and other topics, according to CIGNA Medical Director Dr. Robert Hoover, Jr.

  • Thousands more New Yorkers may be able to receive Medicaid-covered home care and stay out of institutions, thanks to a recent ruling from an administrative law judge at the New York State Department of Health. The ruling will allow an elderly man to shelter some of his income used for rent and food in a trust administered by a third-party non-profit group, and therefore qualify for coverage for Medicaid home care services, reports The New York Times.

    Whether the ruling will set a precedent for other cases is still questionable, experts say.

  • Rotech Healthcare Inc. is trying to fill Apria's shoes, at least when it comes to Gentiva Health Services. Orlando-based Rotech and Melville, NY-based Gentiva have inked a deal for Rotech to furnish respiratory therapy and DME to Gentiva CareCentrix managed care clients in 33 states, Rotech says.

    And Rotech has signed a three-year deal to furnish continuous positive airway pressure (CPAP) devices and related products for treating snoring and obstructive sleep apnea to Gentiva CareCentrix patients in 48 states.

    The contract is expected to generate more than $25 million in annual revenues, says Rotech President and CEO Philip L. Carter. Apria Healthcare Group Inc. announced it wasn't renewing its $45 million contract with Gentiva earlier this year (see Eli's HCW, Vol. XIII, No. 4, p. 31).

  • Two of the Tenet Healthcare Corp. home health agencies that Amedisys Inc. has purchased are First Community Home Care of Dallas and Cypress-Fairbanks Home Health in Houston, report the Dallas Business Journal and the Houston Business Journal. Baton Rouge, LA-based Amedisys recently purchased 11 HHAs and two hospices from Santa Barbara, CA-based Tenet for $19 million (see Eli's HCW, Vol. XIII, No. 9, p. 72).

  • A turf war looks to be brewing in the Wichita, KS wheelchair market. Five employees of Via Christi's Home Medical Services Rehab have left and started a local branch of National Seating & Mobility Inc., reports the Wichita Business Journal. The move left Via Christi's HMS with just one employee, the paper says.

    The National Seating branch says it plans to build some of its wheelchair, scooter and other product business by taking clients away from HMS. Via Christi is hiring three qualified replacement workers "and will continue to include mobility services as part of the one-stop-shop convenience that we offer our customers," HMS President Darryl Graham told the Journal in a statement.

  • Business is booming for Monroeville, PA-based Rx Health Care Group. The 100-employee company's divisions offer infusion therapy, home medical equipment including respiratory equipment, and private duty nursing, among other offerings, reports the Pittsburgh Business Times.

    Owner David Glancy expects Rx's home infusion revenues, $15 million in 2003, to grow 25 percent for the next half decade, the paper says. Glancy predicts Rx's respiratory business, which launched in 2003 after a non-compete agreement expired from a previous sale, will grow 100 percent a year from its first-year revenues of $200,000.

    Staffing shortages, especially for nurses and pharmacists, are the main limits on growth, Glancy told the Times. Rx plans to open a hospice and palliative care division next year, when another non-compete agreement expires.

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