Home Health & Hospice Week

Your billing privileges could be at stake.

A "seriously flawed" proposed rule on survey revisit fees could come back to haunt you--as early as this January.

Representatives of home health agencies recently spoke out strongly against a proposed rule on the topic, submitting a slew of comments to the Centers for Medicare & Medicaid Services by the agency's Aug. 27 deadline.

"We oppose revisit user fees out of hand, but given the broad stroke approach that CMS has taken, we are especially concerned," Kim Skehan of the Connecticut Association for Home Care tells Eli.

"Many things in the proposed rule are just not clear," says Judi Lund Person of the National Hospice & Palliative Care Organization.

Background: CMS published a proposed rule on the topic in the June 29 Federal Register. The rule outlines a plan to charge health care providers a fee if a revisit survey is required to address deficiencies cited during an initial certification, recertification, or a substantiated complaint survey (see Eli's HCW, Vol. XVI, No. 25).

In response, HHAs and other stakeholders fired back official comments on the rule and are seeking Congress' help in delaying the implementation of the regulation. But so far, CMS seems intent on forging ahead with the fees, with collection commencing as soon as the first quarter of the 2008 calendar year.

Key concerns of home health agencies include: • The revisit fees could apply to any deficiency. The proposed rule does not go far enough in defining what constitutes a "deficient practice," some stakeholders said.

Case in point: An HHA could wind up being charged a user fee for a revisit related to a complaint survey--even if the agency had corrected the problem prior to the complaint survey, suggests Skehan. • The methodology for calculating the revisit fees is flawed. "Some provider types will be penalized and others undercharged," suggests Mary St. Pierre of the National Association for Home Care & Hospice. • HHAs will have little recourse to contest a deficiency. The proposed rule would provide a reconsideration process to report what a provider feels is an error of fact. But the process would be of little value to providers, insiders say.

CMS must receive a request for reconsideration within seven days from the date identified on the revisit user fee assessment notice ...quot; an "unreasonable deadline," says NAHC.

• Off-site visits should not be included in the scope of the regulation. In the proposed rule, CMS defines a "revisit survey" to include "offsite" activities, St. Pierre notes. In its comments on the rule, NAHC says that this is "beyond a reasonable interpretation of the term." As defined, agencies could wind up paying user fees to cover what's simply a routine desk review of [...]