Medicare Compliance & Reimbursement

Part B practices will have 16 new tests that you'll be able to report as "CLIA-waived," thanks to a Feb. 11 CMS transmittal on the matter. According to MLN Matters article MM7266, CMS will now consider these tests CLIA-waived.

You'll have to append modifier QW (CLIA-waived test) to these codes, which include the following, among others:

• 87880 -- BTNX, Inc. Strep A Rapid Test
• 86308 -- Consult Diagnostics Mononucleosis Cassette (Whole Blood)
• 82274 and G0328 -- BTNX, Inc. Rapid Response Fecal Immunochemical Test
• G0434 -- Amedica Biotech AmediCheck Instant Test Cup
• G0434 -- On the Spot Drug Testing Multi-Drug of Abuse Urine Test

To read the complete list of new CLIA-waived tests, visit www.cms.gov/MLNMattersArticles/Downloads/MM7266.pdf.

HHAs looking to avoid compliance problems sparked by a congressional therapy investigation of publicly traded home care companies have a new resource: the Delta Excellence in Therapy Report. The report is based on the Delta National Excellence in Therapy Forum, a group of 80 industry experts that met in September 2010, software vendor Delta Health Technologies notes in a release.

The project was convened in response to the high-profile therapy investigations. "In the past year, the national media, the U.S. Senate Finance Committee and even the SEC have expressed concern that there is overuse or misuse of therapy, particularly the number of therapy visits and their impact on reimbursement," Delta CEO Keith Crownover says in the release.

"While the homecare industry may have lacked definitive guidelines, we know it does not lack the caregivers -- physical therapists, occupational therapists, speech-language pathologists, social workers and clinical nurses -- who have the expertise, passion and commitment to develop tips and strategies to insure the most effective, compassionate care. This report is living proof." The report, which includes a section on appropriate use of therapy assistants, is at www.deltahealthtech.com/assets/docs/DeltaExcellenceinTherapy.pdf.

The project was co-sponsored by Delta, the National Association for Home Care & Hospice, and Fazzi Associates.

Medicare Fraud Strike force nails 111 people for over $222 million in false billing. The strike force completed the biggest ever federal health care fraud takedown on Feb. 17, charging people in nine cities for fraudulent schemes, according to an HHS news release. The defendants include a variety of health care professionals, from physicians to nurses to therapists.

For example, 10 people in Brooklyn were charged with $90 million in false billings for physical therapy, proctology services, and nerve conduction testing. Another 11 people were charged in Chicago for billing Medicare over $6 million in diagnostic testing, home health, and prescription drug false claims.

The charges include "conspiracy to defraud the Medicare program, criminal false claims, violations of the antikickback statutes, money laundering and aggravated identity theft," states the release.

To read more about the arrests, visit www.justice.gov/opa/pr/2011/February/11-ag-202.html.