Medicare Compliance & Reimbursement

Hospices would see a 1 percent payment rate increase for Medicare in 2012, if an influential advisory body to Congress gets its way.

That increase would be down from hospices' 1.8 percentincrease this year, notes the National Association for Home Care & Hospice. But the 1 percent update would be better than the zero percent update or cuts that the Medicare Payment Advisory Commission recommended for other provider types.

MedPAC based its recommendation to Congress, which will be contained in its March report, on hospices' 4.2 percent average profit margin figure for 2011, notes the National Hospice and Palliative Care Organization.

Medicare spending on hospice has increased greatly from 2002 to 2009, from $2.9 to $12 billion, MedPAC noted in its Jan. 14 meeting. And the average length of stay has increased from 54 days to 86 days in that time, but median length of stay has remained at just 17 days.

During that time period, the percent of beneficiaries who died using hospice increased from 23 percent to 42 percent.

"No news is bad news" regarding durable medical equipment competitive bidding, says the National Association of Independent Medical Equipment Suppliers. Industry representatives are gathering complaints about the DME bidding program that began on Jan. 1, but the industry isn't getting feedback from physician, referral, and patient communities, NAIMES says. "Since we know problems are there, the lack of reports are likely because these groups don't know where to report problems," the trade group says.

Physicians and clinicians, patients and caregivers, and discharge planners and care coordinators can fill out forms specific to their position at www.competitivebiddingconcerns.com or on the American Association for Homecare's website at www.aahomecare.org.

In December, lawmakers passed the Medicare and Medicaid Extenders Act of 2010, which eliminated the RUG-III hybrid system, an interim payment system required by the healthcare reform act from Oct. 1, 2010 through Sept. 30, 2011. In anticipation that Congress might repeal the provision, CMS rolled out RUG-IV on Oct. 1, 2010, and planned to develop the hybrid system to retrospectively adjust claims, if needed.

The legislation also keeps the Part B therapy cap exceptions process in place through 2011. And it maintains the 2010 Medicare physician fee schedule payment rates during that time frame. Physicians and other Part B providers had been looking at an approximate 25 percent rate cut scheduled to go into effect on Jan. 1, due to a sustainable growth factor adjustment that has accrued over the years.