Home Health & Hospice Week

Cost-based reimbursement still costing agencies big.

An unfavorable decision from the Provider Reimbursement Review Board is giving one Cali-fornia agency a cost-based reimbursement hangover.
 
In its 1994 and 1995 cost reporting years, Los Angeles-based Angeles Home Health Care Inc. claimed more visits than its provider statistical & reimbursement reports showed. Its then-intermediary United Government Services found Medicare had denied the excess visits based on medical necessity, so it moved the visits from the "Medi-care" to "other" visits category.
 
The result was about $34,000 less in reimbursement in fiscal year 1994 and $54,000 less in 1995, according to a Sept. 16 PRRB decision (No. 2004-D39).
 
Angeles appealed the adjustment to the PRRB, arguing that the denied visits should be excluded from the cost report altogether rather than be included in total visits. Including the denied visits in the total visits category "distributes Medicare costs to non-Medicare patients in opposition to Medicare's cross-subsidization rule," the home health agency argued.
 
But the PRRB sided with the intermediary, noting that "excluding denied Medicare visits from total visits would result in the Provider being partially reimbursed for visits which were not entitled to be reimbursed by Medicare."
 
The PRRB returned a similar decision regarding Angeles' 1996 cost report last year (see Eli's HCW, Vol. XII, No. 32, p. 254).
 
Angeles CFO Debbi Gentner says the HHA is asking for administrative review of the decisions. If the Centers for Medicare & Medicaid Services Administrator upholds them, Angeles will most likely proceed to federal court on the issue, Gentner tells Eli.