Industry Notes:
INTERMEDIARY CRACKS DOWN ON DRESSINGS DIAGNOSIS CODE
Published on Tue Sep 13, 2005
Will your V58.3 claims measure up?
Get ready for increased scrutiny for claims with V58.3 as a primary diagnosis.
Regional home health intermediary Cahaba GBA will conduct a widespread review of prospective payment system claims with this code that denotes "Attention to surgical dressings and sutures," the RHHI says in an Oct. 6 posting to its Web site.
"Once selected, the claims will be reviewed for medical necessity," Cahaba says. That includes compliance with Centers for Medicare & Medicaid Services guidelines, contractor local coverage determinations, and correct billing and coding.
The RHHI will post the results of the probe on its Web site and use the information to guide provider education, it says. Topic code 5THBT will indicate the review, Cahaba says. • High gas prices continue to plague home health agencies. Raising its mileage reimbursement rate from the old IRS limit of 40.5 cents to the new limit of 48.5 cents would cost Johnstown, NY-based Community Health Center more than $6,000 a month, reports The (Albany) Business Review.
Albany-based Visiting Nurses Home Care has had a few employees refuse shifts due to high fuel prices, director Kenneth Mooney told the newspaper. Community Health's Paula Reichel said employees have applied for jobs at institutions to avoid the travel inherent in a home care job.
Community Health has sent a letter to patients informing them they might not get to have the health care aide they want if the person isn't in their area that day. "Some [patients] weren't happy about that," Reichel told the Review. • Norcross, GA-based Pediatric Services of America Inc. has agreed to pay New York's Medicaid program more than $239,000 to settle allegations that it sold used durable medical equipment to Medicaid beneficiaries while claiming the equipment was new, state attorney general Eliot Spitzer has announced.
PSAI's Elmsford, NY regional office sold used medical devices, such as pulse oximeters, suction pumps, feeding pumps and compressors to critically ill children, Spitzer alleges in a release. Between January 1998 and December 2003, PSAI purportedly claimed that it sold brand new DME to the Medicaid beneficiaries when other PSAI patients had previously used the equipment. PSAI didn't have proper documentation to verify that the DME the company furnished to patients was indeed new, Spitzer says.
Meanwhile, PSAI has agreed to sell its pharmacy business to Memphis, TN-based Accredo Health Inc. for $72 million in cash. PSAI would keep its Pensacola, FL-based unit dose pharmacy under the deal, which is subject to regulatory approval.
The cash will fund start-ups and strategic acquisitions and pay down debt, PSAI says in a release. • Your carrier or intermediary can request documentation of a sample of your claims if it has already identified an overpayment. The contractor can do this to determine [...]
