Industry Notes:
OIG PUSHES INCREASED PHYSICIAN INVOLVEMENT FOR HHAs, SUPPLIERS
Published on Mon Aug 22, 2005
Hospice-SNF relationships also targeted.
Home care providers could work even more closely with physicians if the HHS Office of Inspector General gets its way.
In its latest compendium of recommendations for improving operations, known as the Orange Book, the OIG tells the Centers for Medicare & Medicaid Services to improve physicians' roles in home care by educating home health agencies and docs about the topic. The OIG also wants CMS to revise the plan of care to relieve the paperwork burden on physicians.
The watchdog agency also urges CMS to improve physicians' relationships with durable medical equipment suppliers. That would include physician education, requiring the physician to treat the patient before ordering DME or supplies, and requiring the physician's name and specialty as well as the patient's diagnosis information on the DME or supply claim.
And the OIG calls for CMS to more closely monitor oxygen equipment claims and to revise and improve suppliers' compliance with Medicare standards.
Finally, the OIG wants CMS to curb inappropriate referrals between hospices and nursing homes. Some current hospice-nursing home contract provisions could allow fraud and abuse, the Orange Book says. • HHAs serving higher case-mix patients are also seeing higher profit margins, research by Medicare Payment Advisory Commission staff reveals. Agencies with the lowest case mix had a median margin of 12.3 percent in 2002 while HHAs with the highest case mix saw a median margin of 22.8 percent, MedPAC staff said in the Sept. 8 meeting of the influential advisory body to Congress.
MedPAC will present its findings on the relationship between case mix and profit margin in a mandated report to Congress Dec. 8. While there is a relationship between case mix and profitability, there are too many variables involved in profit margin to pin down the exact nature of the relationship, MedPAC concluded.
Commissioners want more research on case mix and prospective payment system accuracy in the future to inform PPS refinements, they said. • The gap-filling method to set prices for power wheelchair codes could reduce payments to providers by an average of 25 percent. That's the conclusion of a new study conducted by Muse & Associates for the American Association for Homecare.
When using gap filling to price new DME codes, CMS estimates the price for the 1987 Medicare fee schedule, then calculates the current price using actual increases in fee schedule payments.
The study recommends CMS use 1992 as the historic pricing year for all power chairs, because much of today's technology was developed post-1987. Of the power chair products examined, only nine had pre-2000 price information, according to the study. • The changeover from carriers and fiscal intermediaries to Medicare Administrative Contractors (MACs) doesn't mean the Program Safe-guard Contractors (PSCs) won't keep looking [...]
