Home Health & Hospice Week

Billing report contractor, ZPIC contact docs about home care and hospice referrals.

Reviewers peering over your referral sour-ces’ shoulders may have a slowing effect on your referral stream.

At press time, comparative billing report contractor SafeGuard Services was set to release its CBR on "Attending Providers Certifying Home Health Plan of Care" Aug. 29, the contractor said on its website.

The report will display the top 10 home health agencies a provider is associated with based on the number of beneficiaries for final home health prospective payment system claims with dates of service in calendar year 2012. Other HHAs are grouped into an "All Other HHAs" category.

And the report will show providers the "Number of Home Health Agencies Associated with You" and the "Number of Beneficiaries Whose Plan of Care for Home Health Services Was Certified by You" compared to state and national peers in a bar chart. The report also tells providers in a table if they are "higher" than the national and state average for those statistics.

The Centers for Medicare & Medicaid Services intends for the report to "assist in the identification of possible errors where providers’ NPIs are compromised leading to a provider being indicated as the attending/referring provider without their knowledge," SGS says in a frequently asked question about the report. CMS also wants the reports to "allow providers to identify the number of beneficiaries in their practices which are referred to Home Health Services and the names and number of the Home Health Agencies."

Take-Home Message: "The utilization of home health services is on the rise with an increase in the number of home health service visits, an increase in the number of home health agencies, and an increase in the volume of episodes per beneficiary," SGS tells your referral sources in the report’s introduction. "In 2010, Medicare paid $19.5 billion to 11,203 home health agencies (HHA) for services provided to 3.4 million beneficiaries."

HHS Office of Inspector General "studies have found that home health services are vulnerable to fraud, waste, and abuse," SGS continues in the report to the provider.

Fraud threat: "Home health agencies, as well as the physicians who order home health services, are responsible for ensuring the medical necessity of claims submitted to Medicare," SGS stresses to the provider. "A physician who orders unnecessary home health care services may be liable for causing false claims to be submitted by the home health agency, even though the physician does not submit the claim."

CMS and SGS chose the report because "home health services were identified as a vulnerability to the Medicare Program," the contractor says in the FAQ.

ZPIC Pressures Referral Sources Too

Meanwhile, Region 5 Zone Program Integ-rity Contractor (ZPIC) AdvanceMed sent notices earlier this month to both HHA and hospice referral sources saying the ZPIC would ramp up oversight of them. "Referring providers will be under increased scrutiny related to referrals to hospice providers," AdvanceMed says in the hospice notice. "Ensure that the beneficiaries referred to a hospice agency meet the criteria for the benefit," particularly the six-month prognosis, the ZPIC instructs.

"Referring providers will be under increased scrutiny related to referrals to home health pro-viders," AdvanceMed says in the home health no-tice. "Ensure that the beneficiaries referred to a home health agency meet the criteria for the benefit," particularly the skilled need and homebound status, the ZPIC specifies.

"The aged person who does not often travel from home because of feebleness and insecurity brought on by advanced age would not be considered confined to the home for purposes of receiving home health services unless they meet" the home health benefit criteria detailed in the letter, Advance-Med stresses to referral sources in Zone 5 (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia).

Note: See a sample of the CBR your referral sources may receive at www.safeguard-servicesllc.com/cbr/documents/CBR029 Home Health Plan of Care Sample.pdf and the FAQ at www.safeguard-servicesllc.com/cbr/faqs.asp?id=cbrfaqs28#myfaq.

AdvanceMed’s notices are at www.palmettogba.com/Palmetto/Providers.Nsf/files/Hospice_Referring_Provider.pdf/$File/Hospice_Referring_Provider.pdf  for hospice and www.palmettogba.com/Palmetto/Providers.Nsf/files/Home_Health_Referring_Providers.pdf/$File/Home_Health_Referring_Providers.pdf for home health.