Home Health & Hospice Week

HHAs must plow through mountains of corrections to ensure fair rates in the future. 

If you can barely keep up with your current billing, a requirement for ensuring adequate Medicare payment rates down the road might swamp you.

Starting today, every claim you submit should include supplies charges for patients that use them, experts urge.

The Centers for Medicare & Medicaid Services has fixed a claims processing system glitch that was suspending home health agency bills that included separately itemized supplies, regional home health intermediary Palmetto GBA says in a posting on its Web site dated July 16. The suspensions began in October 2002.

Before the problem was corrected, the supplies line items were stripped from the claims to allow them to process and pay normally (see Eli's HCW, Vol. XII, No. 12, p. 91). Under the prospective payment system, the supplies didn't result in additional payments to the HHA, so taking them off the claim had no immediate effect on an agency's bottom line.

Now that the glitch has been fixed, agencies are free to go back to those claims and add the supplies back in, Palmetto says. RHHI United Government Services sent the same message to its providers July 14, a UGS representative tells Eli.

It's important to add the supplies information back onto claims because CMS and other governmental agencies will use claims and cost report data to set payment rates in the future, notes Mary St. Pierre with the National Association for Home Care & Hospice.

Additionally, the data will be used to calculate figures such as HHAs' profit margins. Artificially high profit margins have weakened HHAs' fight for payment relief in Congress this year, observers note.

But CMS' expectation of HHAs to correct all those claims is "totally inappropriate," St. Pierre insists. Since it was CMS' system that malfunctioned, CMS should be the one to fix the problem, NAHC plans to tell the agency in a forthcoming letter. One way might be to look at HHA supplies costs from other years and add similar amounts into 2003 costs, she suggests.

HHAs that are hard-pressed to keep up with current billing and other administrative requirements won't be able to find the time to go back and correct claims that have no immediate reimbursement impact, experts predict.

The number of claims agencies have to correct will depend on how they handled the supplies billing glitch. Some HHAs omitted supplies information on all their claims to be sure they wouldn't suspend. Others removed the supplies charges only after a claim suspended, resulting in many fewer claims with no supplies.

Supplies data will be used to set future payment rates and calculate figures such as HHAs' profit margins.

The claims suspensions occurred when claims that required a partial episode payment (PEP) or significant change in condition (SCIC) adjustment also included charges for medical supplies using revenue codes 027X and 0623. Reason code E6101 marked the supplies-related suspensions.