Billing:
PPS TRANSITION WEIGHS HEAVILY ON HHAs
Published on Thu Jan 10, 2008
Many agencies are groaning under software burden.
Home health agency staff rang in the New Year with lots of extra headaches related to the prospective payment system changes that took effect Jan. 1.
The changes finalized last August require numerous billing and OASIS adjustments, including the switch to a new three-tiered therapy threshold, addition of separate nonroutine supplies (NRS) reimbursement and grouping based on the early/late episode designation indicated in M0110.
Many Louisiana HHAs had “healthy anxiety” about the billing changes ahead of time, relates Warren Hebert with the HomeCare Association of Louisiana. It’s normal to have “pre-submission jitters” when such a drastic payment system change is on deck, says Lynn Olson with Astrid Medical Services, a Corpus Christi, TX-based billing company.
Many agencies are experiencing burdens with their billing software vendors during the transition, reported some of the trade groups in all 50 states and Puerto Rico contacted by Eli. “It is a nightmare. We are awaiting our third fix from our computer vendor,” reports one Wisconsin HHA. The agency can’t lock OASIS and has not attempted to bill yet, it says.
More commonly, agencies’ vendors were ready, but only with a number of time-consuming software updates. Most vendors seem to be sending “daily edits” and other fixes, notes Vicki Purgavie with the Home Care Alliance of Maine.
“We are in the same boat as everybody else--adding patches to patches on our computer system,” laments a Wisconsin agency. “We have had to run an upgrade to the upgrade and will probably have to run more upgrades as the bugs get worked out,” another Badger State provider adds.
A number of vendors were “cutting it close,” adds Karen Hinkle with the Kentucky Home Health Association. That put extra stress on providers trying to get ready for the changes.
Who’s to blame? But many of the updates were due to CMS issuing notices at the last minute about grouper software changes (see Eli’s HCW, Vol. XVI, No. 41) and payment errors (see Eli’s HCW, Vol. XVI, No. 44-45). The Medicare system won’t pay you correctly for some wound items and diagnosis coding combinations and you won’t receive the correct reimbursement unless you resubmit for it.
There’s been “some understandable frustration from members about the last minute changes to the grouper and CMS laying off the responsibility of finding and correcting them on us,” notes Bob Wardwell with the Visiting Nurse Associations of America.
“Why did they not put it off until they knew what they were doing?” one West Virginia HHA [...]
