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Home Health & Hospice Week

Industry Notes:

CMS FINALIZES 60-DAY DELAY FOR BIDDING

Published on Tue Jan 20, 2009

Feds should go back to the drawing board instead, industry reps insist.

Just days after proposing a short delay to the re-implementation of competitive bidding for durable medical equipment, CMS has adopted the postponement.

"The Centers for Medicare & Medicaid Services has delayed the effective date for the Interim Final Rule with Comment Period that implements ... the Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Acquisition Program," CMS says on its bidding Web site.

"The effective date was originally February 17, 2009 and is now April 18, 2009," CMS adds.

The delay will allow "Department officials the opportunity for further review of the issues of law and policy raised by the rule," CMS continues. The move is due to the Obama administration's directive to hold all unimplemented regulations for review (see Eli's HCW, Vol. XVIII, No. 7, p. 52).

DME suppliers remain unimpressed with the change. "While [the] delay gives the HME sector some temporary reprieve, everything about CMS's handling of the competitive bidding program from the very outset has been troubling," says American Association for Homecare President TylerWilson in a release.

"Starting with the mismanaged implementation in 2008, through the mischaracterization of the program as a fraud prevention effort, to the rush earlier this year ... to ramrod the program through under the cover of the previous administration on its very last day, CMS seems intent on being confrontational with the HME community," Wilson says.

CMS should work with the industry to make sure the program's relaunch goes smoothly, AAHomecare insists. "Or better yet, CMS should work with the HME community to convince Congress that the bidding program will harm beneficiaries and providers alike and should be scrapped," Wilson says.

Suppliers can submit comments on the interim final bidding rule, published in the Jan. 16 Federal Register, until March 17, CMS points out on its site online at www.cms.hhs.gov/DMEPOSCompetitiveBid.

• You may not see Medicare put as many resources as you'd like into programs aimed at reducing hospitalizations.

None of the 15 care coordination programs CMS tried from 2002 to 2005 resulted in overall Medicare savings, according to a report in the Feb.11 Journal of the American Medical Association.

Overall failure: Only one of the 15 programs appeared to reduce hospitalizations significantly,at 17 percent less hospital stays than the control group, says the article authored by CMS contractor Mathematica Policy Research. One of the programs actually had 19 percent more hospitalizations then the control group.

In the programs, nurses provided patient education and monitoring, mostly via phone, to patients with congestive heart failure, coronary artery disease, and diabetes. The goal was improving adherence and communication with physicians, the study notes. Changing physician and patient behaviors is very challenging, Mathematica concludes.

• If you received a flood of additional development requests (ADRs) from regional home health intermediary National Government Services recently, you may be able to ignore them.

The claims processing system's control for the number of ADRs requested malfunctioned, NGS reports in an e-mail to providers. "This resulted in excess claims suspending for some providers for Medical Review," the intermediary says.

"To avoid unnecessary ADR submission, we are advising providers to monitor the status of claims before responding to the ADRs," NGS instructs. The RHHI is releasing the mistakenly ADR'd claims "as quickly as possible."

• If you try to bill Medicare for oxygen equipment repairs or service with HCPCS code E1340 after April 1, you won't get very far. Starting in April, DME MACs will begin denying E1340 claims with dates of service Jan. 1 or later, CMS says in a Feb. 13 transmittal outlining oxygen billing rules (CR 6296). The code will be replaced by K0739.

DME MACs also will no longer pay for K0740, although suppliers can use it to indicate noncovered charges.

More repair and service billing information is in the transmittal online at www.cms.hhs.gov/transmittals/downloads/R443OTN.pdf.

• Home health agencies aren't the only ones stalled by the feds' 2007 directive to hold up initial provider certifications. Hospices in Missouri are complaining about the wait time to get their Medicare numbers and state licenses.

CMS asked states to reprioritize their work with Medicare-certified health care providers in this order: reaccreditation requests, then complaint investigations, then new business certification, notes the Springfield Business Journal. Missouri's Department of Health and Senior Services told hospices last month that new hospice certifications are on hold due to CMS's request from two years ago.

The limit on growth may mean the aging population's needs will go unmet in future years, warned Russ Rogers, CEO of Kansas City-based Omega Health Care Inc., in the newspaper. Omega has a hospice certification application pending.

• The outpatient therapy cap is $1,840 for 2009, but the claims system won't reflect that until April. It will reject therapy claims that exceed the 2008 cap amount of $1,810 until then, CMS says in Feb. 13 CR 6321 (Transmittal No. 1678).

Home health agencies can just resubmit the claim with the KX modifier for payment, CMS instructs in the memo online at www.cms.hhs.gov/transmittals/downloads/R1678CP.pdf. "Claims with KX modifiers shall circumvent the cap rejection in WF," CMS says.

The therapy caps apply only to outpatient Part B therapy, not therapy furnished under a home health plan of care.

• New Hampshire may be one step closer to providing hospice care as a Medicaid benefit. The state Senate has approved a bill to examine the cost benefits of offering hospice under Medicaid.

Only New Hampshire and Oklahoma don't offer hospice care under their Medicaid programs, state Sen. Peggy Gilmour (D-Hollis) told the Associated Press. The bill goes to the state House for approval next.

• A Houston DME supplier is facing Medicaid fraud charges. Ene Etim (Ernest) Hogan of Shanet Medical Source billed Medicaid for incontinence supplies he didn't deliver, that were in excess of the amount delivered, that were medically unnecessary, or that were provided without a proper prescription, according to the U.S. Attorney's Office for the Southern District of Texas.

From 2004 to 2006, Hogan billed $1 million in supplies and received more than $683,000, prosecutors say in a release. Hogan faces 10 fraud counts which could each carry a penalty of up to 10 years in prison and a $250,000 fine.

• Gentiva Health Services Inc. is selling six offices that specialize in pediatric home care, the Melville, N.Y.-based national chain says in a release.The offices comprise more than 80 percent of Gentiva's pediatric operations.

"The transaction fits strategically with Gentiva's stated objective of sharpening its focus on skilled home health services for geriatric patients," the company says. "Our decision to migrate away from pediatric home health care is in keeping with the Company's strategy of focusing on geriatric specialties," CEO Tony Strange adds in the release.

Gentiva will sell the locations in Phoenix, Springfield, Mass., Pittsburgh and State College, Penn. to Andventure Inc., doing business as Loving Care Agency and Links2Care. Loving Care has 25 offices in five states, Gentiva says.

• Amedisys Inc. continues its string of positive earnings reports.

The Baton Rouge, La.-based national chain reports net income of $26.3 million on revenues of $340.1 million for the quarter ended Dec. 31. That's up 58 percent from a $16.7 million profit in the same period of 2007, and up 75 percent from $194.0 million in revenues during that time.

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