Prepare For Battle In Court To Defend Your Compensation
Published on Thu Aug 12, 2004
HHAs that can't afford costly legal fees are stuck with unfair compensation for therapists.
It's become a familiar refrain - the Provider Reimbursement Review Board rules in favor of a home health agency's physical therapy compensation appeal, only to have the Centers for Medicare & Medicaid Services Administrator overturn it.
The result: Unless an agency wants to appeal the CMS decision in federal court, the agency is stuck with the intermediary's reductions to its PT salary costs.
That's what Charlie Wilson, owner and administrator of Pocono Medical Home Care Inc. in Stroudsburg, PA, fears may happen to his small HHA, he tells Eli.
On July 16, the PRRB handed down a decision reversing regional home health intermediary Cahaba GBA's $30,000 cost report adjustment to Pocono's 1997 cost reporting year (Pocono Medical Home Care, Inc. vs. BlueCross BlueShield Association/Cahaba GBA, [No. 2004-D31]).
The issue: Pocono paid its therapists on a per visit basis, so Cahaba applied the salary limits for contracted therapy staff to the therapists' compensation.
A long string of PRRB decisions and a number of federal court decisions spell out that it is not appropriate for Medicare to limit bona fide PT employees' salaries to contractor levels just because agencies pay them on a per-visit basis, notes Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas. But Cahaba (previously Wellmark) continues to make the adjustments, and the CMS Administrator continues to reverse the PRRB decisions favoring the provider.
Because the CMS Administrator "has the power to overturn the decision, what difference does it make?" says a frustrated Wilson. "It's a foregone conclusion that it will be overturned."
And when that likelihood becomes reality, Pocono will have to decide whether it is worth it to go to court over the adjustment's $30,000 reimbursement impact. "It is very expensive to go to court," Wilson says. But "we are keeping our options open - we haven't really decided."
Pocono couldn't choose a different payment method for its employed therapists because "the market dictates per-visit pay," Wilson says. Missed Taxes Lead to Cost Report Losses Meanwhile, RHHI United Government Services has emerged the victor in a tangle over accounting practices for back taxes, according to July 16 decision Global Home Care, Inc. vs. BlueCross BlueShield Association/United Government Services, (No. 2004-D30).
Troy, MI-based Global Home Care Inc. was unaware it owed Michigan Single Business Tax from 1995 to 1998, then learned of its tax liability in 1998, the PRRB decision says. Global accrued the taxes in the fiscal year it found out about them, 1998. But the HHA didn't actually pay the taxes until FY 1999.
When Global tried to claim the tax costs - more than $70,000 - in its FY 1998 report, UGS cried foul. The RHHI said Global had to claim [...]
