Home Health & Hospice Week

Provider mulls federal court appeal to secure therapist compensation.

Yet another home health agency must make the call on whether to proceed with a costly federal court appeal to secure its rightful therapist compensation reimbursement.

Regional home health intermediary Cahaba GBA disallowed nearly $60,000 in physical therapist compensation for a Virginia HHA's fiscal year 1996 and 1997 cost reports, according to a March 3 Provider Reimbursement Review Board decision (No. D-18).

Cahaba applied salary equivalency guidelines for contracted therapists to compensation for physical therapists paid per visit by The Medical Team in Reston, VA, the decision says.

As it has in numerous previous decisions, the PRRB reversed the disallowance, saying the salary guidelines weren't meant to apply to directly employed therapists' compensation. Multiple federal courts, including an appeals court, have ruled likewise on the issue.

"This is an ongoing war," observes consultant Pat Laff with Laff Associates in Hilton Head Island, SC. The HHS Administrator is sure to reverse the PRRB's decision as it has similar ones previously, Laff predicts.

"The cases continue to tumble out of the PRRB and the Administrator on this issue," agrees attorney Joel Hamme with Powers Pyles Sutter & Verville in Washington, DC.

The Medical Team fully expects the reversal, says its attorney, John Jansak with Harriman & Jansak in Towson, MD. Now the HHA is weighing the pros and cons of going to court to fight the anticipated reversal.

Coordinating the numerous reversals into one court case has proven difficult, says Hamme, who is representing three HHAs in such a case pending in Washington, DC federal court. The delays between when the PRRB cases are decided and when they're announced makes it difficult to alert providers to the option of consolidating their cases into one appeal, which saves costs, Hamme criticizes.

Update: Hamme's current PT compensation appeal is underway. The HHAs are waiting on the government's answer to their filings to see whether it will settle or if they have to file further motions, he says.