Medicare Compliance & Reimbursement

• The Senior Medicare Patrol project may be losing momentum, but it could still cause headaches for your practice if your patients don't understand how Medicare billing works.

In 2008, 57 Patrol projects in all 50 states and Puerto Rico had 4,685 active volunteers who educated beneficiaries in 6,869 group education sessions and held 24,505 one-on-one counseling sessions, the HHS Office of Inspector General says in a recent report. The projects also conducted media and community outreach.

The program aims to teach how to detect and report waste, fraud, and abuse in the Medicare program.

The programs had fewer active volunteers and saved Medicare less money than in previous years, the OIG notes. However, "the projects may not be receiving full credit for savings attributable to their work," the report cautions. Fraud and errors may be reduced "in light of Medicare beneficiaries' scrutiny of their bills."

• Home health agencies aren't the only ones getting

hit with case mix creep cuts. Skilled nursing facilities, long-term care hospitals, and inpatient acute care hospitals are seeing the same treatment from CMS.

CMS has proposed cutting SNF payments 3.3 percent in 2010, with a 2.1 percent offset for inflation, the agency says. The agency wants to cut inpatient hospital rates 1.9 percent, offset by a 2.1 percent inflation update. And CMS has proposed cutting LTCH rates 2.4 percent, minus a 1.8 percent inflation increase.

• Early use of home care services following a hospital stay by patients with at least one chronic disease saved Medicare $1.71 billion in the two-year period from 2005 to 2006, according to a study by Avalere Health.

The study, sponsored by the Alliance for Home Health Quality and Innovation, also found that an additional $1.77 billion would have been saved in the same period if all Medicare beneficiaries with similar chronic diseases had accessed home care services.

Medicare could save $31.1 billion over the next 10 years if it expanded access to home care for chronic care patients, the study contends. The estimated savings would come from reduced hospitalizations and other reduced institutional costs.

AHHQI is an advocacy group founded by six for-profit home care chains.

• Practices that were holding out hope that CMS would change course on its virtual colonoscopy stance are out of luck.

On May 13, CMS issued a decision memorandum indicating that it will not cover screening computed tomography colonographies, which are better known as virtual colonoscopies.

CMS notes in its memo that the "evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test ... CT colonography for colorectal cancer remains noncovered."

Several professional associations announced their disagreement with the decision. "Make no mistake: If let stand, this CMS decision not to pay for CT colonography will cost lives," noted James H. Thrall, MD, chair of the American College of Radiology's board of chancellors in a prepared statement.

• Speech-language pathology telehealth services are gaining new attention in Congress. Rep. Mike Thompson (D-Calif.) recently introduced H.R. 2068, the Medicare Telehealth Enhancement Act of 2009, which would provide Medicare reimbursement for telehealth services conducted by SLPs and audiologists, announced an email to members from the American Speech-Language Hearing Association.

Telehealth consists of monitoring patients remotely, so this legislation would also expand care access (and Medicare reimbursement) to urban and suburban areas, ASHA pointed out.

The legislation has bipartisan support, with Reps. Bart Stupak (D-Mich), Lee Terry (R-Neb.), and Sam Johnson (R-Texas) as original co-sponsors.