Home Health & Hospice Week

Ability to correct minor errors most helpful.  If you're drowning in Medicare's administrative quagmire, take heart: Congress has thrown you a lifeline. Buried in the thousands of pages that make up the newly enacted Medicare Prescription Drug, Improvement and Modernization Act of 2003 lie regulatory reform provisions that could ease home care providers' administrative burdens. The provisions, gathered under the "Regulatory Reform" heading under Title IX of the bill, were signed into law by President Bush Dec. 8 along with the rest of the bill. Probably the most helpful provision will be the one allowing providers to simply correct minor technical errors on claims without going through the timely and costly full-blown appeals process, says the Visiting Nurse Associations of America's Kathy Thompson. The Department of Health and Human Services will work with both its Medicare contractors and provider representatives to develop a process that will allow those simple corrections to take place, according to Section 937 of the bill. Technical denials are the most prevalent type for HHAs, points out William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law. That made getting this provision passed a priority for home care lobbyists. "Denials because of the absence of signed and dated orders prior to billing continue to haunt HHAs," Dombi says. "This provision will allow HHAs to resubmit compliant claims without having to pursue an appeal." Other errors affected by the provision include incorrect dates, beneficiary addresses that change and unexpected hospital stays, explains Thompson. "It affects almost every agency and will really help with cash flow," she cheers. The new process should be in place by December 2004, the bill indicates. Among the host of changes, the following provisions are particularly helpful to home care providers: Overpayments (Section 935). Medicare now is restricted from recouping overpayments until a reconsideration decision on the matter is rendered - in other words, until the provider has exhausted the first level of appeals. "The overpayment recoupment postponement is important to home care because of the limited financial resources available to pay off an overpayment and wait for a successful appeal," Dombi notes. Appeals for deceased patients (Section 939). Because home care providers serve many frail, older beneficiaries, patients often don't live through the appeals process timeline, Dombi says. The provision, which took effect upon enactment, allows providers and suppliers to appeal claims determinations when a patient dies and there is no other party to take up the appeal. Extrapolation limits (Section 935). Medicare is prohibited from extrapolating overpayment amounts unless the provider has a high level of payment errors or "educational intervention" fails to correct the problem, the bill says. "This is very [...]