Home Health & Hospice Week

Rise in doc visits also brings more scrutiny.

Some of your patients may begin receiving more care at home from an unexpected quarter--physicians.

Physician house calls to Medicare beneficiaries increased 40 percent from 1998 to 2004, according to a research letter published in the Nov. 16 Journal of the American Medical Association. That increase is due in part to the 1998 Medicare increase of nearly 50 percent in reimbursement rates for home visits, the letter maintains. The 2004 allowed charge for a comprehensive visit to an established patient was about $110.

Like home health agency care, physician home care prevents expensive emergency room visits and rehospitalizations and allows hospitals to discharge patients sooner, Eric DeJonge, a Washington, D.C.-based physician who works with Washington Hospital Center's Medical House Call Program, recently told National Public Radio.

Medicare is currently conducting a three-year pilot program under which 15,000 Medicare beneficiaries in Texas, California and Florida will have access to in-home care from physicians. The test aims to gauge whether house calls increase cost savings and improve beneficiary health, NPR noted.

Red flag: But the spike in house calls may also be drawing the wrong kind of scrutiny. The feds are investigating Visiting Physicians Association, a Farmington Hills, MI-based company that sends doctors to the homes of more than 25,000 elderly and disabled patients in Michigan, Ohio, Texas, Georgia and Wisconsin, according to Crain's Detroit Business newspaper.

In court filings, the U.S. Attorney's Office and the HHS Office of Inspector General say they are accusing the company of allegations similar to those filed in a 2000 whistleblower lawsuit, the newspaper says. The suit alleged that Visiting Physicians billed the government for medically unnecessary services and manipulated coding to inflate reimbursement.

Visiting Physicians told the paper it is cooperating with investigators and believes it has done nothing wrong. • If you know physicians who've faced rejections of claims with G codes for the new power mobility initiative, tell them to double-check where they've been sending those claims.

The interim final rule on power mobility established a G code--G0372--so physicians could bill the Centers for Medicare & Medicaid Services for the additional cost of reviewing required documentation and getting it to durable medical equipment suppliers. The new code was effective for dates of service on or after Oct. 25, 2005.

But some suppliers report that physicians are getting their G codes rejected, according to the Dec. 15 Home Health, Hospice and Durable Medical Equipment open door forum.

As it turns out, the physicians who got rejections were probably submitting the code to the DME regional carrier--not the local Part B carrier as required.

"It was my understanding that the G code would be billed to the local carrier, not to the DMERC," John Warren of CMS said [...]