Home Health & Hospice Week

Home health agencies and hospices may not technically be under Recovery Audit Contractor reviews just yet, but current issues that at least one RAC is investigating are already affecting them.

Health Data Insights, the RAC contractor for Region D, posted 66 new approved issues for review in January. Most of them apply to hospitals, but HDI is also approved to review durable medical equipment topics. And two of the new DME issues will affect HHAs and hospices, too.

Issue #1: The Centers for Medicare & Medicaid Services approved "DME while in Hospice" as an issue on Dec. 22, 2009. The RAC will look for DME claims improperly paid for beneficiaries in a hospice stay. This could cause suppliers to come knocking on hospice doors for payment for claims dating as far back as Oct. 1, 2007.

Issue #2: CMS approved "Medical Supplies and Home Health Consolidated Billing" as another RAC issue on Jan. 6. Again, the RAC will look for DME and supply claims paid by Medicare thatshould have been covered by an HHA under bundling back to Oct. 1, 2007, which could cause suppliers to go back and ask agencies for those payments.

CMS has approved 10 other DME topics for RAC review: urological bundling, wheelchair bundling, knee orthotic bundling, parenteral nutrition items provided more than once per day, payment for infusion accessories and drugs when the pump is denied, DME payments for patients in a hospital Part A stay, skilled nursing facility consolidated billing, code A4221 more than once per week, prosthetic bundling, and date of death.

Watch for: CMS will post the RACs' medical records limit for 2010 soon, contractor NHIC promised in a recent Ask-The-Contractor teleconference. CMS will post the limit at

www.cms.hhs.gov/RAC/01_Overview.asp.

To read the full list of HDI's open issues, visit https://racinfo.healthdatainsights.com/Public/NewIssues.aspx.