COPs, hospice-nursing home guidance also slated for this year.
Home health agencies may have to wait until almost the end of the year to see the changes coming to the prospective payment system, including the much-anticipated therapy threshold change.
A Centers for Medicare & Medicaid Services official announced at March's National Association for Home Care & Hospice policy conference that CMS planned to issue the proposed rule on PPS refinements some time this year (see Eli's HCW, Vol. XV, No. 13).
Now CMS has slated the rule to come out in November and take effect in January 2008, the agency says in the Department of Health and Human Services semiannual regulatory agenda, published in the April 24 Federal Register.
The rule will propose "the first major refinement to the HH PPS since its implementation on 10/1/ 01," CMS says in the notice.
Keep watch: However, CMS' agenda timelines regularly get delayed, observers warn.
CMS also sets October as the new release date for the re-proposed home health conditions of participation (COPs) and the release date for proposed hospice requirements for long-term care facilities. CMS sets May 2008 as the date for the final rule on the hospice COPs it proposed last year. • A federal rule will target health care fraud by standardizing existing Medicare enrollment requirements used by the various Medicare contractors that process and pay Medicare claims.
"By standardizing the information that a health care provider or supplier must use in order to bill Medicare, we will be better able to protect the Medicare program and assure providers and suppliers that they will be paid promptly," says Timothy Hill, chief financial officer and director in CMS' Office of Financial Management. Among the provisions of the April 20 rule: Most providers must report changes in enrollment data within 90 days of a change, but durable medical equipment suppliers will have only 30 days to notify their CMS contractors.
More information on Medicare enrollment is at
www.cms.hhs.gov/MedicareProviderSupEnroll. • A probe review of claims with long-term drug use code V58.69 has blown up into a widespread review for all HHAs served by regional home health intermediary Cahaba GBA. Starting last December, providers could report codes from this series only as secondary diagnoses.
Cahaba conducted a probe review of claims with the code from Sept. 21 to Dec. 12--mostly before the primary diagnosis code prohibition took effect. Even so, the probe of 50 providers' claims found an error rate of 47 percent, Cahaba says in an April 25 posting to its Web site.
"The largest reasons for denials were related to the lack of documentation to show this was an effective treatment for the beneficiary's condition, or because there was an oral alternative, and no documentation why the oral medication wasn't [...]
