Home Health & Hospice Week

Why should home health agencies have to pay for the Centers for Medicare & Medicaid Services' mistakes when physicians don't?

That's the question many in the home care industry are asking after CMS announced it would forgive and forget overpayments it accidentally made to docs earlier this year.

Physician claims with dates of service in January or February were supposed to be paid at 2002 rates. But due to claims processing limitations, if they were submitted after March 1, they were paid at higher 2003 rates.

CMS had planned to go after those overpayments in a "mass adjustment" in July - and has been warning doctors about the move for months. But CMS recently told physicians it decided against making the recoupments.

"If CMS can forgive physicians for overpayments created by CMS software glitches, why can they not treat HHAs the same way?" asks Gene Tischer of the Associated Home Health Industries of Florida.

"I hope the answer isn't that physicians are more deserving ... or that they contribute more to political campaigns," says William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law.

HHAs' pleas for relief actually should have more merit than docs', Dombi argues. The physician payments were made much more recently than most of the HHA payments that will be recouped for missed partial episode payment adjustments.

And physicians knew ahead of time that they would be overpaid, Dombi points out, while most HHAs have no idea an episode should have been PEP'd. That's especially true if the patient was admitted by another agency unbeknownst to the original HHA.