Home Health & Hospice Week

You can report your managed care beefs to CMS officials.

Even if your record is spotless, you'll still be under scrutiny in Medicare's new home health fraud demonstration project.

The Centers for Medicare & Medicaid Services is requiring home health agencies in Los Angeles and Houston to reenroll in Medicare (see Eli's HCW, Vol. XVI, No 26). The demo also included other fraud-fighting activities and on-site reviews.

Detail revealed: All HHAs in the target locations will be subject to the reenrollment requirement, confirmed CMS' Jim Bossenmeyer in the July 18 Open Door Forum for home care providers. The affected areas are Harris County, TX and four southern California counties--Los Angeles, Orange, Riverside and San Bernardino, Bossenmeyer explained to a caller.

But the agency was unwilling to divulge any further details about the project, saying officials were still working out the particulars. A question from the Visiting Nurse Associations of America's Bob Wardwell about why the effort was a demonstration project rather than a program integrity measure went unanswered, as did a question from a California caller wanting to know when to expect the reenrollment letters.

Those letters' timing will be vitally important, because HHAs will face disenrollment from Medicare if they fail to reapply within 60 days of the request.

Don't: But agencies shouldn't try to get a jump on the problem by submitting CMS form 855A ahead of time, Bossenmeyer warned in the forum that drew 450 callers. Don't submit the reenrollment applications in advance of the intermediary's request, he instructed.

CMS will offer more demo information at next month's Open Door Forum, Bossenmeyer pledged.

Other issues addressed in the forum include:

• Bidding affects you too. HHAs and hospices won't go untouched by durable medical equipment competitive bidding. Providers in bid areas will have to contract with a supplier who wins the bid for their area, said CMS' Joel Kaiser.

"If you're a hospice and you're used to dealing with one supplier for providing the DME, you're going to have to deal with a [bidding] contract supplier if your normal supplier did not win a contract," Kaiser explained.

• Report your managed care beefs. If you have proof of abusive marketing practices or payment problems from Medicare managed care plans, you should report them to CMS. Mary St. Pierre of the National Association for Home Care & Hospice asked for a CMS contact person for such complaints in the forum and CMS responded to NAHC later with the information, the trade group reports.

But don't go running to CMS with every little complaint about Medicare Advantage plans. "Reports of MA plan marketing improprieties should be based on factual details about the improper marketing practices," NAHC says in its newsletter to members. And reports about reimbursement "should be based on patterns of nonpayment that are indicative of systematic problems that could threaten beneficiary access to care, not simply disputes over details of individual contracts."

Contact: For the CMS official's contact information, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "MA Contact" in the subject line.