Home Health & Hospice Week

Hospitals could take steps to alter their home care transfer policies if they're forced to tighten up their related billing. Hospitals with high error rates for post-acute transfers could be in for aggressive enforcement actions from federal regulators. Hospitals collected more than $60 million in overpayments in 2000 based on improperly classifying transfer patients as discharges, the HHS Office of Inspector General estimates in its latest review of post-acute transfer compliance. Under the post-acute transfer policy, if a hospital discharges a beneficiary in one of 10 specified diagnosis related groups to a post-acute provider - including home care - the hospital should treat the discharge as a transfer for payment purposes. That means Medicare pays the hospital a per diem rate for the patient's care, rather than the full DRG amount. Compliance with the rule is something of a train wreck. Out of 200 claims the OIG reviewed, 188 resulted in improper payments, the agency says in "Compliance with Medicare's Postacute Care Transfer Policy for Fiscal Year 2000" (A-04-02-07005). One problem could be that a hospital has no way of knowing whether a patient receives home care after discharge. Nevertheless, both the OIG and the Centers for Medicare & Medicaid Services are frustrated with the results - and the agencies may be about to pounce. "We are interested in exploring potential cooperative arrangements with OIG to identify, investigate, and sanction abusive hospitals," CMS chief Tom Scully warns. Tough enforcement could mean hospitals become stingier with home care referrals. The DRGs affected by the policy are 014, 113, 209, 210, 211, 236, 263, 264, 429 and 483. The report is at http://oig.hhs.gov/oas/reports/re-gion4/40207005.htm. The OIG is investigating Gentiva Health Services Inc. and served the company with a document subpoena April 17, the Melville, NY-based home health giant revealed in its quarterly filing with the Securities and Exchange Commission May 14. The subpoena seeks information regarding implementation of prior settlements with the government, implementation of corporate integrity agreements and Gentiva's "treatment on cost reports of employees engaged in sales and marketing efforts," the company says. Gentiva is cooperating with the government and is talking with it regarding the "timing and scope of production," it says. The government hasn't filed a complaint against the company to Gentiva's knowledge, the company notes in the filing. Payors need to loosen up their requirements for hospice and palliative care to be more flexible, says a new study by the National Institutes of Health. Limiting hospice and palliative care to patients with a six-month prognosis means many patients who need the services must go without, says the study that appeared in the May 14 issue of the Journal of the American Medical Association. Only 23 percent of [...]