OASIS Alert
Prepare Now For Your Intermediary's New Year's Gift
M0175 recoupment bills arrive soon. You won't have a moment to spare if you want to contest any of the M0175 overpayments the feds are about to claim.
By Jan. 18, 2007, regional home health intermediaries will issue demand letters, by first class mail, for all net overpayments resulting from M0175 adjustments for fiscal year 2001. They will include the report of the claims adjustments that make up the overpayment (see Eli's OASIS Alert, Vol. 7, No. 11, for details of the recoupment).
Providers should be prepared to review these letters immediately to confirm the amount is correct, experts advise. If you want to appeal any of the adjustments in the demand letter, your appeal must be back to the RHHI no later than 16 days after the date the RHHI sent the letter to you.
"It will be critical that agencies closely review their letters immediately upon receipt to verify whether the overpayments are indeed correct," stresses consultant M. Aaron Little with BKD in Springfield, MO.
• The Centers for Medicare & Med-icaid Services is switching the contractor it uses to host OASIS questions-and-answers, so the current Q&A Web link soon will be changed, noted CMS' Pat Sevast at the Nov. 8 Home Health Open Door Forum. The agency will issue a new address for OASIS Q&As shortly. At press time, the old Q&As were still available at www.qtso.com/hhadownload.html.
• CMS published its final rule for the calendar year 2007 rate update for a Medicare prospective payment system home health episode. For episodes ending in 2007, the base rate is $2,339.00. The final rule also contains per-visit rates for modified episodes such as LUPAs. The final rule is available at www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1304f.pdf.
• Medicare won't cover infrared therapy devices for treatment of diabetic and non-diabetic sensory neuropathy, wounds and ulcers, CMS has announced. This includes the treatment of related pain.
Non-covered therapies include monochromatic infrared energy (MIRE), according to decision memo CAG-00291N. For more information, go to www.cms.hhs.gov/coverage and click "What's New."
• Changes in Medicare home health reimbursement have affected home health utilization for patients undergoing orthopedic procedures, according to the findings of a new study. With the advent of home health's prospective payment system, utilization rates fell significantly, researchers note.
"Larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals," they report.
The research appears in the journal Medical Care (2006; 44 (9): 870-878).
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