Home Health & Hospice Week

PPS, OBQI also addressed in forum.

You might have to transition to a new Medicare contractor as early as next year, thanks to a revamp of the contracting reform strategy.

Medicare's switch to Medicare Administrative Contractors from intermediaries and carriers has been going on a while. Durable medical equipment regional carriers (DMERCs) switched to DME MACs last summer.

But home health agencies and hospices thought they were fairly insulated from the MAC transition because the Centers for Medicare & Medicaid Services originally planned to keep the four regional home health intermediary regions about the same and to bid the RHHI-to-home health MAC business separately from the Part A and Part B MACs.

But CMS has changed its mind about that. Now  the agency will integrate the home health and hospice workload into four of the remaining seven Part A/Part B MAC contracts awarded this year, said a CMS staffer at the April 2 Open Door Forum for home care providers. "There was a shift in the procurement strategy," he informed attendees.

Bad news: And unfortunately for chains, CMS will require home health agencies and hospices to submit their claims to their MAC based on geography. Chain locations will no longer be allowed to send claims all to one contractor, the staffer confirmed.

CMS has a chain option with MACs, but it's only for institutional providers, he explained.

The switch could prove very disruptive for HHAs and hospices, fears Bob Wardwell with the Visiting Nurse Associations of America. Providers could wind up with a different intermediary/MAC, and even a contractor with no home health or hospice experience.

The new MAC regions vary from the current ones, Wardwell tells Eli. That means lots of providers will see changes even if the current RHHIs win the bids. "While the systems are more standardized than they were 10 years ago, there are still unique front-end and rear-end systems at each RHHI," he says. "Not to mention a whole new set of staff relationships to develop."

Timeline: CMS will award contracts for the home health work by the end of the year and would expect all claims to transition to the new contractors by the end of 2009, the CMS official said.

Other issues raised in the forum include: • PPS billing. CMS has yet to set a date for resolving the episode sequencing problem discovered more than a month ago (see Eli's HCW, Vol. XVII, No. 10). Under that problem, the Common Working File isn't recognizing 2007 episodes when determining episode sequence for M0110. As a result, the system is coding all episodes as early even when they really are later episodes.

"CMS is working with our contractors to get this problem corrected, but I don't have a date for the correction to the problem [...]