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Home Health & Hospice Week

Industry Notes:

FEDS SHOULD TOUGHEN UP SURVEYS, NEW REPORT URGES

Published on Fri Feb 27, 2009

Home care providers could see more frequent visits from surveyors.

The Government Accountability Office has taken a look at Medicare survey procedures and isn't happy with what it's found, which could make home care providers' lives harder but help stem fraud and abuse.

In 2007, most states were unable to complete their survey workload due to surveyor staffing shortages and other funding shortfalls, the GAO found in its new report (GAO-09-64).

In 2000, HHAs, which are surveyed every three years, comprised about 3 percent of state surveyors' workloads. In 2007, that increased to 4 percent. Hospices, which are surveyed every seven years, made up 1 percent of surveyors' workload in 2000 and less than 1 percent in 2007, the report notes.

About 86 percent of HHAs received state surveys in 2007 instead of surveys from private accrediting organizations, the GAO points out.

The GAO gave the Centers for Medicare & Medicaid Services a laundry list of recommendations for toughening up surveys and improving their funding structure to prevent missed or inadequate surveys. Among the suggestions: consider implementing user fees for those organizations surveyed and increase survey frequencies.

Resource: The report is online at www.gao.gov/new.items/d0964.pdf.

• Suppliers of negative pressure wound therapy devices will see payment cuts from Medicare if the HHS Office of Inspector General gets its way. The OIG recommends that CMS use its inherent reasonableness authority to cut NPWT pump payment rates and include the pumps in its second round of competitive bidding, according to a new report (OEI-02-07-00660).

According to the OIG, suppliers paid an average of $3,604 for new NPWT pump models, compared to Medicare's purchase price of $17,165.Suppliers made back their purchase price in about two months of rental, the OIG contends.

The price of such pumps has gone down considerably, thanks to market competition, since Medicare set the reimbursement rate in 2001, the OIG says.

The report is online at www.oig.hhs.gov/oei/reports/oei-02-07-00660.pdf.

• You'll have to use a workaround until October to get your hospice claims that contain physician services paid, says regional home health intermediary Cahaba GBA. A problem with the Outpatient Code Editor is causing hospice claims that contain physician services to return to provider(RTP) with reason code W7072.

To get such claims paid, first remove the physician services from the claim and F9 your claim, Cahaba instructs in a listserv message to providers. Then "once the claim has processed (P B9997), you may submit an add-on claim (TOB 8X5) for the physician charges which were removed from the claim," the intermediary says.

Tip: "If you have an add-on claim (8X5) in RTP with RC W7072, you must wait to F9 the add-on claim until the resolution to this issue is implemented," Cahaba adds.

The system will fix this error in October, so use this workaround until then, the RHHI advises.

• The durable medical equipment industry is preparing to marshal its arguments against competitive bidding for an April 1 hearing held by the Senate Finance Committee's Subcommittee on Health. Industry reps expect the tone of the hearing to be pro-bidding.

Suppliers' cause received a recent boost from the Wall Street Journal, which ran a March 19 article about bidding highlighting the patient access and choice problems inherent in the program.

Under the aborted first try at bidding, the number of wheelchair suppliers in Miami would have gone from about 400 to four, Peggy Hathaway of the United Spinal Association tells the Journal. "If you're in the wrong wheelchair, you can develop sores, infections," the patient advocate says. "And then Medicare ends up paying for the hospitalization or surgery because your wheelchair didn't fit you properly."

• Home care providers aren't the only health care entities to have the Federal Trade Commission's Red Flags Rule take them by surprise.In a survey of 100 hospitals nationwide by consulting company Compliance Coach, 91 percent were not yet in compliance with the rule and 73 percent were surprised to find out the rule applied to them, the San Diego-based company found.

The FTC will start enforcing its Red Flags Rule for health care providers starting May 1. Under the new requirement, most providers must have identity theft precautions, processes, and procedures in place or face penalties (see Eli's HCW, Vol. XVIII, No. 10, p. 77).

"It is prudent for medical providers to attain compliance quickly in order to mitigate non-compliance risk from plaintiff lawsuits," Compliance Coach advises.

• The Medicare deadline for DME suppliers to purchase surety bonds will remain May 4 for new suppliers and Oct. 2 for already enrolled suppliers, CMS confirmed in its March 17 special Open Door Forum on the bonds.

Companies with more than one National Provider Identifier can obtain a single $50,000 surety bond, but all the locations' addresses must be on the bond, relates the American Association for Homecare. The bond amount will increase for "adverse legal actions," AAHomecare adds.

• Home health agencies are participating in Baton Rouge, La.'s attempt to reduce hospitalizations via Medicare's Care Transitions pilot project.Hospitals and nursing homes have also joined in.

Baton Rouge is one of 14 areas working on the project nationwide, notes the Baton Rouge Advocate. The program is following pneumonia, heart attack, and congestive heart failure patients. A health coach sees patients before hospital discharge,48 hours after discharge, and at a week, two weeks, and a month later.

The coach helps patients compile questions for their physician, discusses medications, and helps the patient prepare a self-care plan, the newspaper says. "Patients have been very receptive; family members are relieved there was an extra person there to watch out," says RN Laurie Robinson, director of quality for the project at Quality Improvement Organization Louisiana Health Care Review.

• Starting April 6, you won't get far in securing answers to your Medicare contractor questions if you don't have some vital numbers handy.

On that date, contractors will start requiring three items -- National Provider Identifier number, Provider Transaction Access Number (PTAN) (often referred to as OSCAR or Legacy), and the last five digits of your tax identification number (TIN) -- to access automated or live customer service, CMS reminds providers in a March 4 MLN Matters article.

The article is online at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6139.pdf.

• A new resource from RHHI Cahaba GBA might clear up your questions about billing for osteoporosis drugs. The drugs are excluded from prospective payment system bundling and are paid on a cost basis, the intermediary reminds HHAs in a new information page. However, the costs of administering the drug are included in the PPS rate and should go on PPS claims, Cahaba explains.

More billing information, including relevantrevenue and HCPCS codes, are at www.cahabagba.com/rhhi/claims/home_health/osteo_drugs.htm.

• National chain Amedisys Inc. is entering the Maryland hospice market with a planned purchase of a home health and hospice agency from Upper Chesapeake Health System and St. Joseph Medical Center in Baltimore, the Baton Rouge,La.-based company says in a release. Amedisys already has HHAs in the certificate of need (CON) state. The agencies had annual revenue for 2008 of about $11 million. Amedisys says.

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