Home Health & Hospice Week

The Centers for Medicare & Medicaid Services top spot has been vacant for three years, but now President Obama is prepared to nominate a CMS Administrator. Obama will put forward Dr.Donald Berwick, a pediatrics and health policy professor at Harvard and head of the Boston-based Institute for Healthcare Improvement.

Berwick has focused on increasing quality of care and efficiency, reports The New York Times. Patient safety has been a major goal of his, says The Wall Street Journal.

The National Association of Independent Medical Equipment Suppliers is cautiously optimistic. "NAIMES views this appointment as good for the DME industry," the trade group says in a message to members.

• A payment system glitch is holding up your reimbursement for hospice claims with physician kidney disease education codes. "Claims with 81X and 82X Types of Bills (TOBs) and ... HCPCS Code G0420 or G0421, with dates of service on or after January 1, 2010, are not paying out of the correct trust fund," reports regional home health intermediary Cahaba GBA.

Don't expect to see payment for the claims until this summer. "We are holding claims that meet the above criteria until the successful installation of the July 2010 Quarterly Release on July 5, 2010," Cahaba says in a message to providers. Cahaba will release and process the claims after the update.

Reminder: G0420 is the CPT code for educational services for chronic kidney disease, per individual. G0421 is the code for CKD education group services.

• Durable medical equipment suppliers should be contacting their elected representatives in the U.S. House and Senate to urge repeal of DME competitive bidding, says a coalition of industry trade groups.

"The Medicare 'competitive' bidding program for home medical equipment will lead to reduced access to medical equipment and services," says a release from the American Association for Homecare, NAIMES, Accredited Medical Equipment Providers of America, Committee to Save Independent HME Suppliers, The MED Group, and VGM Group. "This program is designed to drastically cut the number of providers in the HME sector," they say.

The health care reform package signed into law last month expands the program, NAIMES points out in a separate message.

Bidding "creates a race to the bottom in terms of quality of care for Medicare seniors and people with disabilities," AAHomecare's Tyler Wilson says in a release about the reform legislation. "This bid program will actually reduce competition by putting most providers out of business, even if they agree to rock-bottom reimbursement rates," Wilson says.

The reform package also requires a face-to-face exam for all HME items and services, eliminates the first-month purchase option for standard power wheelchairs, imposes an excise tax on medical device manufacturers, eliminates the 2 percent increase for Round One bid items in 2014, and includes a yet-to-be-defined productivity adjustment cut, AAHomecare says.

• If you haven't registered for the new provider statistical and reimbursement (PS&R) system, you'd better get on it. "Cost Report season is officially underway for agencies with a 12/31 Fiscal Year End," says cost report preparation firm Boyd & Nicholas in Rohnert Park, Calif.

"It can take a month to complete the registration process, and you don't want to be late," Boyd  & Nicholas says in a new Frequently Asked Questions document about the PS&R change. "A delay in your PS&R will not justify a delay in the filing of your cost report."

HHAs can register in the new system at www.cms.hhs.gov/iacs. Most agencies use PS&R reports for their cost report data.

Tip: An agency employee must register in the system -- "it cannot be your CPAor consultant," Boyd & Nicholas stresses.

• Get ready to defend your hospice neuro claims. As part of the implementation of a new Hospice Neurological Conditions Local Coverage Determination, RHHI Palmetto GBA is formulating a "Brief ICF Core Set for Neurological Conditions in Hospice and Palliative Care" document, Palmetto medical director Harry Feliciano says in the intermediary's April newsletter for providers.

Palmetto will take "letters of interest" on the topic from hospice and palliative care organizations submitting claims to the contractor. Comments are due by April 30.

Palmetto also is inviting interested palliative care physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, respiratory care (therapy) practitioners, clinical social workers, and chaplains to form a Neurological Conditions Workgroup. The group will "help improve the quality of the information supporting reasonable and necessary hospice and palliative care services for Medicare beneficiaries with neurological conditions," the newsletter says.

• You can scratch one kind of rehab off the list of services you're responsible for under home health prospective payment system bundling. "Cardiac Rehabilitation is not a part of consolidated billing under the home health benefit," Palmetto GBA explains in a new question and answer set on its Web site.

"Cardiac Rehabilitation is an outpatient service incident to physician services and diagnostic procedures," Palmetto further clarifies. "Cardiac Rehabilitation is reimbursed by the patient's Medicare Part B benefit."

• Don't forget to report certain changes in your surety bond to the National Supplier Clearinghouse, or you could be out of compliance with the surety bond regulation.

What qualifies: DME suppliers must report three bond changes to NSC, CMS says in March 26 Transmittal No. 332 (CR 6854) -- "(1) a change in bond terms, (2) a change in the bond amount, or (3) a location on a bond covering multiple non-chain locations is being added or deleted." Asupplier must submit a bond addendum or a new bond in those cases, CMS specifies.

"Be certain to comply with these changes," CMS tells suppliers in a related MLN Matters article.

Also: Surety bond issuers must notify the NSC if there's a lapse in coverage of a supplier, CMS adds.

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R332PI.pdf. The MLN Matters article is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6854.pdf.

• Your patients might be eligible for disease self-management training provided under $27 million in grants furnished to states.

HHS is awarding the money to states, who will work with Area Agencies on Aging and public health departments to provide chronic disease selfmanagement training to seniors.

"Chronic disease can negatively affect quality of life and threaten the ability of older adults to remain independent within their own homes and communities," HHS says in a release. "The more chronic diseases an individual has, the more likely that individual will become hospitalized."

In addition to improving health, the initiative is expected to save money. "Two-thirds of Medicare spending is for beneficiaries with five or more chronic conditions," HHS notes.

More information on the program, which is funded under the American Recovery and Reinvestment Act, is at www.aoa.gov/AoAroot/PRESS_Room/News/2009/03_18_09.aspx.

• If you have an opinion about the Joint Commission's National Patient Safety Goal on medication reconciliation, now's the time to share it.

The Oakbrook Terrace, Ill.-based accrediting body has proposed revisions to the goal, after hearing from providers that it was difficult to implement effectively.

"The NPSG now spotlights critical riskpoints in the medication reconciliation process," says the organization formerly known as JCAHO.

"The remaining components of the medication reconciliation process are covered in other standards."

The commission is requesting comments on the new goal by April 30. More information is at www.jointcommission.org/Standards/FieldReviews.

• Home care agencies sometimes have a tough time convincing seniors to let staff into their homes -- and now that task might have gotten even tougher.

According to news reports, home care aide Yamilette Hidalgo has confessed to killing her home care patient, 67-year-old Brooklyn, N.Y. resident Maria Torres.

Hidalgo first told police a man broke into Torres' apartment, attacked Hidalgo, and killed Torres. But under police questioning, Hidalgo changed her story and claimed Torres first attacked her and that Hidalgo killed Torres in self-defense. As part of her initial ruse, Hidalgo allegedly gave herself cuts on her face and called 911 in a panic, reports The New York Daily News.

The aide has been charged with murder,says Channel 7 News.