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Home Health & Hospice Week

Industry Notes:

CMS GIVES PROVIDERS AN EXTRA 2 YEARS TO IMPLEMENT ICD-10

Published on Fri Jan 23, 2009

New coding system target date is 2013, according to final rule.

If you were concerned about the proposed ICD-10 implementation date of Oct. 1, 2011, take heart. The Centers for Medicare & Medicaid Services has extended that date by two years, according to a recently published Department of Health and Human Services final rule.

You'll have to ensure compliance with ICD-10 by the effective date of Oct. 1, 2013, according to a Jan. 15 HHS press release. The new edition of the ICD manual will expand the code set from 17,000 codes, which ICD-9-CM currently has, to more than 155,000 codes, which ICD-10 includes.

"HHS received more than 3,000 comments on the ICD-10 proposed rule, and support for transition to the ICD-10-CM and ICD-10-PCS is strong throughout the healthcare industry," says Kerry Weems, acting CMS administrator, in the release.

Home care provider groups, including the National Association for Home Care & Hospice, urged CMS in their comments to delay the implementation date (see Eli's HCW, Vol. XVII, No. 44-45, p. 346). The rule is at  www.federalregister.gov/OFRUpload/OFRData/2009-00743_PI.pdf.

• The newly minted Obama administration continues to send signals that it will take Medicare cost-cutting seriously -- which could result in cuts to home care providers' payments.

In a Senate confirmation hearing for White House Office of Management and Budget Director nominee Peter Orszag, Orszag noted that Medicare and Medicaid spending will equal 20 percent of the U.S.'s gross domestic product by 2050 if their growth continues at pace. "We appear to have massive opportunities to reduce health care costs without harming health outcomes," Orszag said in the Jan. 13 hearing, according to press reports.

Meanwhile, President Obama told the Washington Post that Medicare is at the top of his reform list. The reform efforts will require a "bargain" with U.S. citizens, Obama told the newspaper.

• Home health agency claims payment is going far from smoothly in the new year. Both regional home health intermediaries National Government Services and Palmetto GBA report payment glitches that are affecting agencies.

NGS "is currently experiencing problems processing some debit/credit adjustments through HIGLAS," the RHHI says in a message to providers. "Since Home Health final claims process as debit/credit adjustments if they are tied to a RAP, the issue mainly affects Home Health providers."

NGS is working with CMS and claims system contractors to resolve the problem, it pledges.

And Palmetto still hasn't fixed a problem that it announced in November. Claims submitted via DDE between Nov. 3 and Dec. 2, 2008 received a duplicate document control number (DCN) that is hanging them up in FISS Status/Location SM95HG, Palmetto says in a message to providers.

"We are keenly aware this issue is affecting sequential billing for some Home Health and Hospice providers," Palmetto stresses. "This situation is national in scope and is getting significant attention."

Palmetto advised providers last month to seek accelerated payments over the issue if necessary (see Eli's HCW, Vol. XVII, No. 44-45, p. 355).

"Previously issued accelerated payments are scheduled for recoupment beginning March 2, 2009, at the earliest," Palmetto says on its Web site. "We anticipate a resolution to this issue shortly and apologize for any inconvenience this has caused our providers."

• On Feb. 2, the National Supplier Clearinghouse will begin assigning "fraud level indicators" to all durable medical equipment suppliers applying for Medicare enrollment.

The NSC's four levels will be low, limited, medium and high, CMS says in Dec. 31, 2008, CR 6282 (Transmittal No. 280). An example of a low risk applicant would be a national drug store chain, CMS says, while an example of a high-risk applicant would be a "very small space diabetic supplier with low inventory in a high fraud area whose owner has previously had a chapter 7 bankruptcy."

The NSC will base the analysis on seven factors -- experience as a DMEPOS supplier with other payers, prior Medicare experience, geographic area, fraud potential of products and services listed, site visit results, inventory observed and contracted, and accreditation, according to the transmittal.

Also: "The NSC-MAC should monitor and assess geographic trends which indicate or demonstrate that one geographic area has a higher potential for having fraudulent suppliers," CMS says.

The NSC will assign fraud level indicators for 95 percent of enrolling suppliers and update those indicators annually, the transmittal says.

The transmittal also points out that the NSC can reject a supplier's application if it fails to produce requested supporting documentation within 30 days. The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R280PI.pdf. A related MLN Matters article is at www.cms.hhs.gov/mlnmattersarticles/downloads/MM6282.pdf.

• HHAs in Minnesota aren't taking their low quality scores lying down. After a high-profile newspaper story showing that the state's agencies ranked fourth-lowest in the nation for federal quality scores, the HHAs have launched a research and training program intended to move the state into the top 10, reports the Minneapolis Star Tribune.

The Minnesota HomeCare Association has hired industry expert Robert Fazzi to analyze the problem by looking at data about agencies and patients and surveying agencies for more detailed information, the newspaper says.

The National Association for Home Care & Hospice is helping with the Minnesota project, which it sees as a tool other low-ranking states will use, the Star Tribune says. Texas, Vermont, and Wyoming scored lower than Minnesota on the 30 quality measures considered.

MHCA intends to start training HHAs for improvement in the spring in hopes of improving scores to the top 20 percent by 2011, the newspaper says. "We know that we typically provide good care, even excellent care," MHCA head Neil Johnson told the Star Tribune. "We're going to find out why our scores are so low ... then we'll work to correct it."

• Don't expect the HHS Office of Inspector General to let up on scrutiny of health care providers any time soon. In 2008, HHS saw $2.35 billion in court orders for repayments due to OIG investigations and another $1.33 billion in OIG audit recoveries, the watchdog agency says in its 2008 Performance Report.

The OIG's healthcare oversight efforts brought a $17 to $1 return on investment, the agency reports. To see the full report, go to www.oig.hhs.gov/publications/docs/budget/FY2008_APR.pdf.

• The home health pay for performance demonstration project is halfway through its term, but CMS isn't divulging any details yet. In its newly updated "Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Feefor-Service Program," CMS notes that the home health P4P project will run through December 2009.

CMS also issued newly updated roadmaps for quality and resource use measurement at www.cms.hhs.gov/QualityInitiativesGenInfo.

• Legislation coming out of the U.S. House of Representatives is looking promising for hospices. The House's new economic stimulus bill calls for the Budget Neutrality Adjustment Factor (BNAF) cuts to be postponed one year, retroactive to Oct. 1, 2008, notes the National Hospice and Palliative Care Organization.

"But, it is way too soon to celebrate," NHPCO warns. "This is just step one in a complicated legislative process." The Senate still must issues its bill and the houses must come to agreement on the legislation.

• Hospice chain Odyssey Healthcare Inc.has acquired Flint, Mich.-based Avalon Hospice,according to a release. Avalon is a non-profit hospice with an average daily census of about 80. The acquisition will expand Odyssey's service area in the state.

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