Home Health & Hospice Week

The feds are taking another step to help DME suppliers avoid billing mistakes due to home health consolidated billing.

The Centers for Medicare & Medicaid Services has urged HHAs to bill timely in order to help suppliers avoid claims rejections due to home health prospective payment system bundling (see Eli's HCW, Vol. XIX, No. 16, p. 123). When agencies fail to bill quickly, the patient doesn't show up in the Common Working File as being in a home health episode, leading a durable medical equipment supplier to think it's clear to bill for bundled supplies. Beginning Oct. 1, CMS will make available a new auxiliary file that will display to providers whether a physician has billed for a home care certification or recertification for a patient, and if so, when she billed for it. "That will provide an additional indication that that beneficiary is in a home health episode," explained CMS's Wil Gehne in the July 7 Open Door Forum for home care providers.

Only so much: Suppliers should use this file on top of the existing CWF search and other procedures they use to determine home care status, Gehne said. And like the CWF information, the file will only be as useful as the claims that provide the  data for it. If physicians bill late, their claims may not show up when suppliers are looking for them.

CMS pays for cert and recert services for less than 40 percent of home care episodes, Gehne added. "It's additional and supplementary information, but it's not going to be a magic bullet."

Remember: "The beneficiaries and their caregivers remain the first and the best source of information about a beneficiary's home health status," Gehne stressed.

Other issues addressed in the forum include:

• Competitive bidding. In the first Open Door Forum held after CMS made its DME competitive bidding round 1 bid prices and other information public, the agency made no presentation about the program.

Suppliers would like to hear more information about the program and instructions for winning bidders, suggested Walt Gorski with the American Association for Homecare.

In response to a question about small businesses, CMS's Martha Kuespert did note that the agency had set a 30 percent target for small business in awarding contracts. CMS exceeded that target by offering 48 percent of contracts to small businesses, Kuespert said.

Suppliers would also like to see a list of bid losers as well as contract winners, Gorski urged. CMS will announce contract suppliers in mid- September, a CMS official noted.

• Face-to-face requirement. Like home health agencies and hospices, DME suppliers also saw a face-to-face encounter requirement enacted in the health care reform law. In response to a question from Gorski, CMS's Lori Anderson noted that the home health prospective payment system proposed rule will not address the DME face-to-face requirement.

The provision will be included in later, separate rulemaking, a CMS rep said.