Home Health & Hospice Week

 PRRB sides with intermediary over interpreter disallowance.

Home health agencies that failed to obtain necessary contracts with subcontractors under cost-based reimbursement could still be sorry.

Providence-based VNA of Rhode Island Inc. has learned that lesson the hard way, according to an Aug. 5 decision from the Provider Reimbursement Review Board (No. 2003-D42).

Regional home health intermediary Associated Hospital Service of Maine disallowed about $127,000 in interpreter costs from Viva Brasil in the VNA's 1997 cost report, resulting in an $84,000 adjustment in the agency's payments, according to the decision.

AHS argued that Medicare regulations require HHAs to have a written contract, including an "access clause," with subcontractors that perform more than $10,000 worth of services in a year. The clause allows Medicare auditors to access the subcontractor's records for up to four years.

The VNA lacked a contract with the interpreter service altogether, then the service went out of business. That meant when the problem was brought to the agency's attention during an audit, it couldn't rectify the situation, says the decision.

The VNA countered that it kept thorough and detailed records of its invoices from and payments to the company for Spanish and Portuguese translation services, and that it met the intent of the access clause.

Also, in its prior cost report, the VNA used Viva Brasil's services much less. Thus, the agency didn't know it would do more than $10,000 in business in 1997's cost report period, it said.

 Invoices Aren't Enough, PRRB says

The services were well documented, but without a contract with an access clause, Medicare can't pay for them, the PRRB decided. Medicare regs clearly state that payment is prohibited without the contract and clause.

Also, "regardless of the volume of services the Provider may have obtained from the contractor in the prior year, it did acquire in excess of $10,000 in services from the contractor in the first month of the subject cost reporting period," the Board notes. "This volume of services should have immediately prompted the Provider to obtain the required access document."