Home Health & Hospice Week

Cuts could develop quickly as congressional session winds down.

Previously proposed cuts to home care providers' Medicare reimbursement have been laid to rest, but a new threat could be emerging.

New legislation coming out of the Senate Finance Committee would avert the 10 percent payment reduction to physicians slated for Jan. 1. But instead of proposing home care cuts to pay for the change as the former State Children's Health Insurance Program bill did, reductions to Medicare Advantage plan rates would solely pay for the bill.

MA plans are a favorite target amongst lawmakers after the controversy over unethical marketing by so-called private fee-for-service plans (see Eli's HCW, Vol. XVI, No. 20). But "this is not a slash and burn exercise here on Medicare Advantage," Democratic committee aide Shawn Bishop said in a statement.

The legislation is far from finalized, experts warn. Although it doesn't contain home care cuts at the moment, legislators could easily add them in, especially if the powerful managed care lobby proves persuasive and Congress must look for another funding source for the physician payment fix.

Congress is currently working under continuing resolutions that allow the government to operate past the Sept. 30 fiscal year end, although no appropriations bills have been passed. More CRs are likely forthcoming, observers note.

Ray of light: President Bush has signed a bill that may give home health agencies hope. A "health extenders" bill (H.R. 3668) signed into law Sept. 29 pares the amount by which the Centers for Medicare & Medicaid Services can reduce hospital payment rates for alleged upcoding under the inpatient prospective payment system. The bill reduces the hospital upcoding adjustment from 1.2 percent to 0.6 percent in 2008 and  from 1.8 percent to 0.9 percent in 2009.

HHAs hope that Congress will include similar provisions to curb the 10.96 percent in cuts over four years that CMS plans under home health PPS. • Is the worst over? That may be on the minds of federal officials as well as suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) now that the bidding window in the first round of Medicare competitive bidding has closed.

All bids in the first round were due Sept. 25. The final numbers aren't in, but CMS estimates that it received more than 15,900 bids. Of those, about 60 percent will win contracts. • You can count on one more variable to make the new year even crazier than usual. CMS has set a deadline for Medicare providers to begin using National Provider Identifiers. "Effective January 1, 2008, your Medicare fee-for-service claims received must include an NPI in the primary fields on the claim (i.e., the billing and pay-to fields)," CMS says in a message to providers

You can submit NPI/legacy [...]