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 [...]
