Home Health & Hospice Week

If you've been seeing claims problems this month, you're not alone.

Regional home health intermediaries Palmetto GBA, Cahaba GBA, and National Government Services have reported incorrect claims payments due to the July claims system update.

The problem: "Home health claims and adjustments where the original or adjustment amount ended in zeroes were truncated and the zeroes were dropped from the payment calculation,"

Palmetto explains on its Web site. "This has resulted in underpayments and some overpayments on claims processing ... on or after July 9." "The claim detail of these claims was correct within the remit," NGS says on its site. "However, the payment difference will appear in the 'adjust to balance' field."

The solution: The claims system problem has been fixed already, Cahaba reports, so future claims will pay correctly. The RHHIs are working on a process to issue owed payments to providers.

"Providers do not need to take any action on claims that were paid incorrectly," NGS notes.

• Physicians are unanimous in saying home care services really improve health quality and reduce costs. However, a survey by the Massachusetts Medical Society in collaboration with the Home Care Alliance of Massachusetts notes barriers to physicians' use of these services.

Administrative burdens, reimbursement issues, and lack of access prevent Massachusetts doctors from tapping home care services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home.

Physicians cite the main advantages to home care as reduction in inpatient hospital admissions (89 percent of respondents), better compliance with the patient's care plan (78 percent), reduced stress on caregivers (73 percent), improved coordination of care (65 percent), and fewer visits to emergency departments (63 percent). The majority of the physicians (97 percent) say the services help them better manage their patients' care at home.

The survey report is at www.massmed.org/HomeSurvey09.

• The fraud hammer continues to pound home care. A federal grand jury has indicted 42 people in a Los Angeles fraud scheme that furnished Medicaid-reimbursed home care via unlicensed staff. Former home health agency owner Priscilla Villabroza, a registered nurse who ran a Santa Fe Springs-based company called Medcare Plus Home Health Providers, pleaded guilty in federal court last year to five counts of health care fraud.

Now authorities have arrested 20 more people in the scam that allegedly defrauded Medi-Cal of $4.6 million, says U.S. Attorney Thomas O'Brien. From 2004 to 2007, Villabroza and others hired unlicensed individuals to provide services to disabled Medi-Cal patients and billed Medi-Cal as if they were licensed vocational nurses (LVNs), O'Brien says in a release.

The indicted defendants face felony fraud charges that carry decades of jail time.

Meanwhile, the Centers for Medicare & Medicaid Services' and Department of Justice's Health Care Fraud Prevention and Enforcement Action Team (HEAT) strike force in Houston is drawing local praise.

The program is already detecting hundreds of millions in fraud, the Houston Chronicle reports. U.S. Sen. John Cornyn (R-Texas) has introduced a bill that calls for a real-time surveillance program to monitor Medicare claims, the newspaper says.

• The problem of hospital readmissions has moved up another notch on Medicare's priority list, now that the statistics are listed on the Hospital Compare Web site. Home care providers could benefit from the development by partnering with hospitals to reduce those readmissions, experts say.

Rehospitalizations are "a possible indicator of how well the facility did the first time around," CMS notes in a release.

"One in five Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month," CMS says. "Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama's health care reform agenda." Specifically, the site will show new data on 30-day readmissions for heart attack (average 19.9 percent), heart failure (24.5 percent), and pneumonia (18.2 percent) cases. The measures are riskadjusted, CMS adds.

"Readmissions are too common and costly, and ... they are often preventable," CMS maintains in a fact sheet about the new data.

The data is on the Hospital Compare site at www.hospitalcompare.hhs.gov.

• If you're a home medical equipment supplier who plans to give up your Medicare business when accreditation and surety bond requirements take effect this fall, there's one more thing you should do besides submitting a voluntary termination notice via the CMS-855S.

"Suppliers who do not plan to stay enrolled in Medicare are strongly encouraged to notify their beneficiaries as soon as possible so the beneficiary can find another supplier," CMS urges in a message to providers.

• Don't waste time and resources sending in extra documentation if you're appealing a claim determination on an additional development request (ADR) from intermediary National Government Services. "Providers are no longer required to send copies of the initial documentation submitted in response to an ... ADR for medical review," NGS says on its Web site. "These initial records become part of the provider's appeal file, which will be available for subsequent levels of appeal."

But you should submit any omitted documentation, additional documentation to support the service billed, and supporting statements, NGS recommends.

You'll also need the correct appeal form.

• If an incorrect NPI-legacy number match is messing up your billing, you don't have to go through the whole reenrollment process rigamarole again. Providers can fax a change of information CMS-855 form to get the NPI problem fixed without the contractor waiting on the snail-mail copy and signature, CMS says in July 10 Transmittal No. 296 (CR 6499).

"The contractor shall not use this process to resolve any other enrollment issue other than the correction of the NPI-legacy identifier combination," CMS says in the transmittal.

However: Providers must have completed an 855 update after May 2006 to use this fast-track correction process, CMS cautions.

• Soap operas could soon be helping certain elderly beneficiaries to access home care services. The National Institutes of Health has awarded a $375,000 grant to a University of Arizona College of Nursing researcher to use a Spanish telenovela to emphasize the benefits of home care. The Spanish-language show will target Spanishspeaking Latino elderly benes.

Home care improves outcomes for patients and caregivers, notes home health nurse and principal investigator Janice Crist, associate professor at the college. "However, Mexican-American elders did not use home health care as much as they could." More information about the study is online at www.nursing.arizona.edu.

• The home care mergers and acquisitions market continues to keep busy despite -- or perhaps because of -- the flagging economy.

Hospitals continue to sell off their home care units. Edward Hospital in Naperville, Ill. has sold its home care business to Michigan-based Residential Home Health, reports the Naperville Sun. The hospital did buy a stake in Residential's Illinois operations, however. The acquisition is Residential's first foray out of its 34-county Michigan service area, the newspaper says.

And Downey Regional Medical Center in Downey, Calif. is selling its home health agency to Accredited Home Health Services. Accredited is a California chain that employs 2,200 staffers who provide home care and HME to more than 12,000 patients per month, the company says in a release.

In Charleston, S.C., the Kanawha-Charleston Health Department will auction off its Home Health Service on the courthouse steps. The program was losing up to $50,000 a month, reports WCHS Radio. State law requires the courthouse auction. The minimum bid will be $650,000.

Finally, Coral Springs, Fla.-based OMNI Home Care has acquired certain assets of Homecare Solutions Group based in Boynton Beach, Fla., it says in a release. "This transaction marks OMNI's first acquisition since its partnership with the Goldman Sachs Urban Investment Group and MBF Healthcare Partners in 2008," the company notes. "This addition will more than double our market share in Southeast Florida," says OMNI's Tracy Clark. OMNI plans to eventually expand nationwide, it says.