Advanced Search

Home Health & Hospice Week

Industry Notes:

Physician Cert Payments Hit Hurdles

Published on Thu Mar 18, 2004

Faculty date of service instructions hold up doc home care funds.

Home health agencies may not want to count on Medicare payments to physicians for certifying and recertifying home care plans as a blockbuster marketing tool, if the docs can't get paid.

The National Association for Home Care and Hospice says it has discovered three circumstances in which physicians are having trouble getting paid for certs and recerts:

1. Carriers tell physicians to use the date of the verbal order or the date the home care plan is signed. Instead, carriers should tell them to use the 'from' date on the home health POC, NAHC tells the Centers for Medicare & Medicaid Services in a letter requesting action on the physician payment issue.

If not, claims are denied when the date isn't within the patient's home health episode or if it appears the physician is billing for more than one cert/recert in a 60-day period.

2. Carriers require a copy of the POC with every physician cert/recert claim. "This requirement is analogous to subjecting physicians to 100 percent prepay review," NAHC objects. Carriers should limit review to problem providers.

3. Carriers deny cert/recert claims if the only documentation submitted is the POC. A final rule on the payment defines the service as "when the physician signs the certification," so POCs should be sufficient evidence, NAHC urges.

  • Don't ignore those record requests you get from AdvanceMed, or your agency's bottom line will suffer.

    AdvanceMed is the Program Safeguard Contractor that is performing Comprehensive Error Rate Testing (CERT) reviews, regional home health intermediary Palmetto GBA says in a notice on its Web site.

    If HHAs fail to respond to AdvanceMed's record review request of paid claims, the claims "are adjusted to deny," resulting in "the recoupment of Medicare payments from the provider," Palmetto warns.

    When responding to an AdvanceMed request, HHAs should be sure to send the records to AdvanceMed, not Palmetto; attach the original bar code scan sheet to the record requested; and submit the record within 45 days, Palmetto says.

    Phone and mail contact, and even on-site visits, may be in store for agencies that fail to respond to AdvanceMed requests, Palmetto cautions.

  • After four years of planning, husband and wife Michael and Catherine Scleipfer have opened a home medical equipment "super store" in Nashua, NH, reports The (Nashua) Telegraph. ACP Home Medical Products offers a showroom with a "mind-boggling" array of wheelchairs, ambulatory aids, ADL devices and other HME products.

    The one-stop shop for HME items gives customers a chance to see, feel and try out many of the products, the paper says.

  • Amedisys Inc. saw a handsome earnings increase last year, from $752,000 in net income on $129.4 million in revenues for 2002 to an $8.4 million profit on $142.5 million in revenues in 2003, the Baton Rouge, LA-based HHA chain reports.

    Amedisys will continue to focus on internal growth and "selective acquisitions," it says. Internal Medicare patient admission growth for 2003 was 9 percent over its 2002 figures, the company says.

  • Sunrise Senior Living Inc. is expanding its Sunrise At Home non-medical home care program to Chicago, the McLean, VA-based company says. The company, which primarily runs assisted living facilities, also has private duty home care programs in Atlanta, Boston, Philadelphia, Northern Virginia/Maryland and Southern Florida, it says.

  • Georgia HHAs aren't having an easy time growing their businesses. The state approved only five applications for existing providers to expand services and just one application to start a new HHA business, reports the Atlanta Business Chronicle. Twenty-two applications were denied in the certificate of need state.

    Guardian Home Care of Central Georgia LLC was the only agency approved to establish a new HHA -- in Athens, the paper says. Agencies approved to expand services are United Home Care in Cleveland, Chattahoochee Valley Home Health Care in Columbus, Amedisys Home Health of Macon, Tugaloo Home Health and CareSouth HHA Holdings Inc. in Augusta.

  • The Justice Department has launched a probe into American Retirement Corp.'s therapy provision, the Brentwood, TN-based senior living and HHA company says. American Retirement said it will cooperate, and that it believes the probe is related to therapy furnished at a single community it manages, reports the Associated Press.

    American Retirement was founded by the owners of HCA (formerly Columbia/HCA), the family of Senate Majority Leader Bill Frist (R-TN), according to Hoover's Online.

  • New York Attorney General Eliot Spitzer is suing Special Touch Home Health Care Services, one of New York City's biggest home care companies, for $3 million related to overtime payments for its workers.

    Spitzer alleges Brooklyn-based Special Touch didn't follow rules requiring it to pay the required $7.73 overtime pay rate for weekly hours worked over 40, according to the New York Times.

    An attorney for Special Touch says Spitzer is misinterpreting the state's overtime law, and that it has paid workers legally, the Times says.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All