Home Health & Hospice Week

Per-visit pay open to abuse, CMS contends.

Another home health agency will head to federal court to obtain its rightful reimbursement for physical therapist compensation.

Intermediary Cahaba GBA imposed salary limits for outside therapist contractors to the compensation of directly employed therapists of VNA of Washington, DC. But in a July 19 decision, the Provider Reimbursement Review Board overturned the disallowances for cost reports years 1996 through 1998 (Decision No. 2006-D33). As it has in a string of similar decisions, the PRRB maintained the salary caps don't apply to direct employees, even if they are paid per visit.

Then in a decision released last month, Centers for Medicare & Medicaid Services then-Deputy Administrator Leslie V. Norwalk reversed the PRRB's favorable judgment. A per-visit compensation arrangement for staff therapists "is subject to the same possible abuses that arise in the situation of the use of an outside contractor," Norwalk insisted in the decision.

Home health agencies have successfully ap-pealed or settled cases on the same issue, notes attorney Joel Hamme with Powers Pyles Sutter & Verville in Washington, DC.

The VNA intends to appeal the case to federal district court, notes its attorney, Carel Hedlund with Ober Kaler in Washington, DC. • Get ready for a new batch of HCPCS codes included in home health bundling. "The HH consolidated billing code lists are updated annually, to reflect the annual changes to the HCPCS code set itself," CMS reminds providers in Oct. 27 Transmittal No. 1082.

CMS will add 13 codes, delete seven codes and redefine one code that agencies will be responsible for under the home health prospective payment system.

For a copy of the changed codes, email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Bundled Codes" in the subject line. • If you're looking for falls education and prevention materials for your patients, you may want to check out the National Institutes of Health Web site. NIH has put new falls information on its Web site geared toward older adults at http://nihseniorhealth.gov/falls/toc.html.

• Home care providers shouldn't have to worry about patients accidentally enrolling in a Medicare managed care plan this year.

Last year, the federal government supported its new prescription drug benefit by automatically enrolling dual eligible beneficiaries in private Medicare drug plans. They often ended up enrolled in an all-over managed care plan as well that restricted or underpaid home care services.

In 2007, CMS won't auto-enroll the 632,000 such benes, CMS says. But dual eligibles still may end up with a drug plan. Because many of these benes will miss the open-enrollment period of Nov. 15 to Dec. 31 to sign up, the group has an extra three months to enroll without incurring a penalty for lateness, says CMS spokesperson Kathleen Harrington. • [...]