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Medicare Compliance & Reimbursement

IN OTHER NEWS ...

Published on Sat Apr 11, 2009

•Medicare is nearly halfway finished with naming its new fraud-fighting contractors.

The third Zone Program Integrity Contract --" or (ZPIC) --" Rockville, Md.-based AdvanceMed Corp., will cover Zone 5: West Virginia, Virginia, North Carolina,South Carolina, Georgia, Alabama, Mississippi,Tennessee, Arkansas, and Louisiana. AdvanceMed is currently a Program Safeguard Contractor for 15 states and is a wholly owned subsidiary of Computer Sciences Corp.

Background: The Centers for Medicare & Medicaid Services is awarding ZPIC contracts in seven zones. ZPICs will take over PSCs' program integrity functions.CMS already has announced the contracts for zones four and seven and the contractors have begun operating.

In March, CMS issued a draft of its final solicitation for the remaining ZPICs in zones 3 (Minnesota,Wisconsin, Illinois, Michigan, Ohio, and Kentucky) and 6 (Pennsylvania, New York, Maryland, DC, Delaware,Maine, Massachusetts, New Jersey, Connecticut, Rhode Island, New Hampshire, and Vermont), according to the federal government's Federal Business Opportunities Web site, which lists vendor contract details.

• The Department of Health and Human Services has declared a national public health emergency over swine flu, but don't think that will let you out of any regulatory requirements.

The emergency declaration is the same as those issued for natural disasters like Hurricane Katrina and recent flooding, HHS notes.

But unlike with those declarations, HHS "has not declared a waiver of requirements under section 1135 of the Social Security Act (SSA)," warns the National Association for Home Care & Hospice.

"Providers will have to wait for the secretary to authorize waivers under section 1135 before any regulatory waivers can be initiated."

• Don't let your referring physicians slide by with stamped signatures on plans of care and verbal orders, or you could pay the price in denied Medicare claims.

"Stamped signatures are not acceptable on any medical record," says regional home health intermediary Cahaba GBA, whose reviewers have seen an increase in the banned documentation.

"Medicare will accept hand written, electronic signatures or facsimiles of original written or electronic signatures,"Cahaba says in its May newsletter.

CMS unveiled the stamped signature ban in 2007 and refined its guidance on the matter last year.

• Buckle up for a potentially bumpy ride when Medicare Administrative Contractor National Health Insurance Corp. takes over from regional home health intermediary National Government Services on May 15.

But your transition will be smoother if you keep an eye out for an important "Cutover Communication" that will arrive in your mailbox soon. It will contain important contact information and instructions for your transition such as telephone inquiry CSR, IVR, and TTY numbers; an electronic claims submission timetable and Help Desk number; and mailing addresses for appeals, correspondence,and enrollment forms, NHIC says in a message to providers.

NHIC is the first MAC to take over from an RHHI.The other two new HH MACs, Highmark Medicare Services and Noridian Administrative Services, haven't yet set their transition schedule, a Centers for Medicare & Medicaid Services official said in an industry conference last month. The Government Accountability Office will make decisions on contract protests for those jurisdictions by early May and the transitions will proceed from there, the staffer said.

Highmark will take over agencies currently served by Cahaba GBA while Noridian will take over NGS/United Government Services' workload. Palmetto GBA will continue as the HH MAC in its jurisdiction.

• As most practices know, successful e-prescribers qualify for a two percent incentive payment for 2009. But if you were confused about what constituted a "qualified e-prescribing system" -- or what the claims entailed -- CMS has some answers.

On April 23, CMS released several documents to guide practices along the way as they ease into e-prescribing.The following documents are accessible on the CMS Web site at www.cms.hhs.gov/ERxIncentive/06_EPrescribing_Measure.asp:

• E-Prescribing Measure Specifications

• Claims-Based Reporting Principles for E-Prescribing Incentive Program

• Sample E-Prescribing Claim.

• Florida's legislature is considering approving a

competitive bidding program for incontinence products,AAHomecare notes.

"Similar proposals have been debated in Indiana and Ohio regarding bidding programs for incontinence supplies in Medicaid," the trade group adds.

"Selective contracting will limit a patient's choice of supplier, limit the range of products available to patients,and add to the complexity and confusion in receiving health care services since beneficiaries are likely to require the services of multiple health care suppliers," AAHomecare says.

The newly formed state trade group Florida Alliance of Home Care Services is lobbying against the program.

• Fans of negative pressure wound therapy have more ammunition on their side.

Multiple studies presented at the 22nd Symposium on Advanced Wound Care/Wound Healing Society Meeting in Dallas support the therapy, notes V.A.C. Therapy device maker Kinetic Concepts Inc. in a release.

One of the studies compares NPWT versus advanced moist wound therapy. During the active treatment phase, patients treated with V.A.C. therapy had fewer hospital admissions and amputations, a Boston University School of Medicine researcher says in the study.

• Don't forget to respond to record requests from your Comprehensive Error Rate Testing (CERT) contractor,urges RHHI National Government Services.

But just responding isn't enough. Make sure the records are legible and include records for all dates of service on the claim, the intermediary reminds home care providers on its Web site.

"Please ensure that the medical records submitted provide proof that the service(s) was ordered by the MD and rendered," NGS adds. "Also provide justification to support the medical necessity."

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