Home Health & Hospice Week

LUPA PEPs safe from recoveries.  By the time you read this, it may be too late to see how much money your intermediary will be taking off your bottom line due to partial episode payment adjustments. It's important for home health agencies to go online and peruse the claims their regional home health intermediary is holding for PEP takebacks. All the RHHIs have issued instructions on how to check those PEPs (see box, this page). By looking at those claims, HHAs are able to see how much money the RHHIs will take back over the next 24 months as they gradually release the adjustments. They are recovering the PEP money now because the claims processing system failed to make the adjustments in the first two-and-a-half years of the prospective payment system. But at least one intermediary is offering only a narrow window of opportunity for agencies to look over their pending PEP adjustments. HHAs served by Palmetto GBA have only from July 17 to July 28 to peruse the PEP'd claims, the RHHI says in a notice posted on its Web site and dated July 15. Giving agencies only two days notice that they have a little over a week to look at the claims isn't enough, critics charge. It takes time for HHAs to find out that the information is even available, let alone check it online. "I am positive that is not enough time," says Melanie Golson of the Home Care Association of Alabama. On the other hand, HHAs that really care about this issue have been watching Palmetto's Web site like hawks ever since the PEP schedule was announced, notes Karen Hinkle of the Kentucky Home Health Association. They will be on top of the notices and the timeframe should be adequate. "Hopefully they are checking the site and printing out the list of their claims affected," Hinkle says. RHHI Cahaba GBA made the PEPs available online July 7, and United Government Services made them available July 22. UGS HHAs' claims will sit in the location that is accessible to HHAs until the intermediary pulls them up to adjust (and recoup) them, a UGS official confirms. "Some claims will be there for two years ... until they get pulled up," the source explains. But the situation is different for agencies served by Associated Hospital Service of Maine. Because the RHHI accidentally ran most of its PEP adjustments back in April, it can't run them again. Instead, AHS will withhold 5 percent of an agency's normal payment every week, the RHHI says in a July 18 Medimessage. That withholding "closely simulates the small batch process" that other RHHIs are using, AHS says. The withholds will terminate when an [...]