Medicare Compliance & Reimbursement

Plus: Watch out for in-house identity thieves.

If you had an opinion regarding the changes in the proposed 2010 Physician Fee Schedule, CMS wants to hear it -- again. Due to a technical glitch, some public comments on the Fee Schedule were not accepted in CMS's system, according to an Aug. 21 CMS announcement. "A minor software problem resulted in the nontransmittal of some public comments from July 26, 2009 through July 30, 2009," the CMS directive indicates.

Therefore, if you submitted comments on the proposed fee schedule between those dates, you should resubmit them before the deadline (Aug. 31).

To make your comments electronically, visit www.regulations.gov and enter CMS-2009-0058 to comment on the fee schedule.

• Here's how one agency acted quickly to protect its client's privacy. If you think your patients' confidential identity information is always safe in your staffers' hands, think again. The Minnesota Department of Health's Office of Health Facility Complaints (OHFC) has substantiated a complaint against a St. Paul home health aide accused of using her patient's identity to open a line of credit, KSTP channel 5 news reports.

The aide's employer, Home Instead SeniorCare of Coon Rapids, first caught wind of the scam when one of its clients received a credit card he never applied for. He contacted his bank and began the process of tracing how his credit was being used. During that time, the aide attempted to pay a $572.26 cell phone bill using the illegal card.

Aide's excuse: The aide first attempted to avoid criminal charges by claiming that the client wanted to take over her cell phone contract. When that didn't work, she changed her story, saying the attempted charge was for new wheels for the client's scooter. However, neither story checked out.

Home Instead asked the OFHC to investigate the case and is working with authorities to properly penalize the aide, and protect their client's private information.

• You'll have 18 lab codes that you'll be able to  eport as "CLIA waived,"thanks to an Aug. 21 CMS article on the matter. According to MLN Matters article M6570, CMS will now consider the additional tests CLIA-waived effective October 1. You'll have to append modifier QW (CLIA-waived test) to these codes, which include the following, among others:

• 82274 -Jant Pharmacal Accutest immunological fecal occult blood test

• 84703 -Siemens Clinitek status urine chemistry analyzer

• 82962 -Roche Diagnostics Accutrend Plus System (fingerstick whole blood)

• 87804 -- EarlyDetect Pro influenza A test

• 80101 -- 1-Step Detect Associates DTX drug test cup integrated E-Z split key cup II

• 86318 -- Inverness Medical Signify H. pylori whole blood

• 87880 -- Inverness Medical Signify strep A cassette.

To read the full MLN Matters article, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6570.pdf.

• Suppliers waiting for the onset of competitive bidding now have a firm deadline for the program. The Centers for Medicare & Medicaid Services will begin accepting bids for durable medical equipment in nine metro areas starting Oct. 21, CMS' Competitive Bidding Implementation Contractor said on its Web site.

The bid window will be open for 60 days, and CMS will announce the bid rates and begin contracting with suppliers in June of next year, the CBIC said. The program will go into effect in January 2011. Suppliers can begin signing up for bid system user IDs and passwords on Aug. 17, according to CMS estimates.

There are a few changes from the original Round One bid, CMS noted in a release. Puerto Rico will now be excluded from the bid areas, and negative pressure wound therapy items and Group 3 complex rehabilitative power wheelchairs will be excluded from the list of bid items. Otherwise the bid areas and items remain the same. You can access more bidding information, including the detailed timeline and entire slate of educational sessions and materials, at www.dmecompetitivebid.com.

If you aren't sure whether your subsidiaries and new acquisitions are following the rules, now's the time to find out. Unfortunately, an Ohio home care agency is learning that lesson the hard way.

Viaquest Home Health has reached a settlement with the New Jersey Division of Consumer Affairs to stop placing uncertified home care aides with patients or employers who need help from a certified aide, according to the Asbury Park Press.

The agreement comes after an investigation into Viaquest Home Health LLC of Toms River. Viaquest made no admission of liability and admitted that it did not thoroughly examine the Toms River location when it was purchased in 2007, president and CEO Richard Johnson told the AAP.

Fallout: The state Attorney General did not monetarily penalize Viaquest for failing to follow the rules but did place new requirements on the company, which include:

• Verifying the license status of each health care practitioner prior to placement or referral;

• Verifying the practitioner's work history by confirming employment at all locations for the one-year period prior to placement or referral and not placing someone whose qualifications don't match the requirements of the patient or employer;

• Conducting an on-site in-home evaluation at least once every 60 days; and

• Conducting criminal background and history checks on all employees.

• Michigan physical therapist faces up to 10 years in prison after pleading guilty to fraudulently billing Medicare for over $1.6 million. A Detroit-area physical therapist (PT) has learned the hard way that fraudulently billing Medicare will eventually catch up with you. According to an Aug. 26 press release from the FBI's Detroit office, the PT pleaded guilty to creating fake therapy files and signing progress notes documenting services that were never actually performed.

The PT, along with several coconspirators, admitted that he falsified claims that were billed to Medicare totaling about $1.6 million, for which Medicare reimbursed $772,800. The PT faces up to 10 years in prison and a $250,000 fine.

• The Joint Commission has a new way for you to cement your role as a leader in the industry: patient safety. The group wants home care leaders to "step up efforts to prevent errors by taking the zero-defect approach used in other high-risk industries such as aviation and nuclear energy, according to its latest Sentinel Event Alert.

Reality: Administrators and clinical leaders set the tone and drive the culture in home care agencies. Therefore, those people are the ones who must shine a light on safety and make it an agency-wide priority, the alert pointed out.

The Commission outlined 14 specific steps that executive and senior level staff should follow if they want to improve patient safety.