Hospices will want to avoid new code indicating Medicare non-payment. The Centers for Medicare & Medicaid Services is establishing a new billing code that will show a patient is under a hospice benefit period, but Medicare won't pay.
Starting July 1, hospices must use occurrence span code 77 in FL36 of the claim when they have failed to get the physician's hospice recert in on time, explains a Medlearn Matters article issued Feb. 15. The code will allow a beneficiary's hospice periods to run continuously in the Medicare system, even though Medicare won't pay the hospice for the days not covered due to the late physician recert.
Following the initial benefit period, subsequent periods of hospice care require a written or oral recertification "no later than two calendar days after the first day of each period," CMS says.
The article (MM3686) is at
www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3686.pdf. Medicare is going one step further toward paying home health agencies for services delivered in an adult day care setting. Under a three-year demonstration project passed in the Medicare Modernization Act of 2003, five HHAs will furnish home care services to up to 15,000 beneficiaries in an adult day care setting, according to a Medlearn Matters article issued Feb. 4.
Participating HHAs will bill for the patients by putting "HHDAYC" in the remarks section (FL84) of their usual RAPs and final claims, CMS explains. Agencies then will receive 95 percent of the customary prospective payment system amount for the patient.
CMS will select the five sites from proposals agencies submit in response to a formal solicitation. The demo is slated to begin in July. More information is at
www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3660.pdf.
An important reminder for home medical equipment suppliers: With no date set for when the new, lower 2005 rates for oxygen will take effect, oxygen providers should play it safe and bill weekly, John Gallagher of VGM told a meeting of the North Carolina Association of Medical Equipment Services this month. That's because once CMS calculates the new fee schedule amounts, providers will be reimbursed at the lower 2005 rates (see Eli's HCW, Vol. XIV, No. 3, p. 19).
Gentiva Health Services Inc. has reported net income of $6.9 million on revenues of $225.5 million for the quarter ended Jan. 2, 2005, compared to a $41.8 million profit on $203.9 million in revenues for the quarter ended Dec. 28, 2003. However, that whopping $42 million in earnings was largely due to a one-time tax benefit, Lake Melville, NY-based Gentiva says.
But the home care chain still is predicting 2005 earnings will be lower than analysts' predictions. Gentiva expects per-share earnings for 2005 to range from 72 cents to 80 cents, while analysts are forecasting 83 cents a share, [...]
