Home Health & Hospice Week

The new depression screening questions in OASIS C may help you achieve better outcomes for your heart disease patients.

Seniors who suffer from heart disease and are subsequently diagnosed with depression are at greater risk for heart failure, according to a new study by cardiac researchers at Utah's Intermountain Medical Center. Researchers also found that taking antidepressant medications to ease depressive symptoms did not appear to mitigate this risk, according to an Intermountain release.

"Our data suggest that depression is an important and emerging risk factor for heart failure among patients with coronary heart disease," says Heidi May, an IMC epidemiologist and lead author.

Researchers found that a depression diagnosis following coronary heart disease was associated with a two-fold increased risk for the incidence of heart failure. This risk remained but was slightly lower after adjusting for other cardiovascular risk factors such as diabetes, hypertension, and age. The incidence of heart failure among patients who were not depressed after being diagnosed with coronary artery disease was 3.6 per 100 compared with 16.4 per 100 for those with a post-heart disease depression diagnosis.

"Patients need to be carefully screened for depression so that interventions that alter some of the risk associated with depression can be used and the related risk of heart failure and other cardiovascular events can be diminished," May urges.

The study was in the April 21, 2009 issue of the Journal of the American College of Cardiology.

• Get ready to see a new remarks message this fall if your claims don't contain the required ordering physician ID number. Starting Oct. 5, intermediaries and carriers will begin Phase 1 of the physician ID edit. They will still process a claim when an ordering doc's National Provider Identifier (NPI) number isn't in the PECOS or contractor file, the Centers for Medicare & Medicaid Services explains in Transmittal No. 510 (CR 6417), reissued June 26. But the claim will carry a new remark code: "M68 (missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification)."

When CMS begins Phase 2 of the project, which doesn't yet have a start date, that claim without a valid physician NPI will get rejected, CMS notes in a related MLN Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf. The reissued transmittal is at www.cms.hhs.gov/transmittals/downloads/R510OTN.pdf.

• A payment system glitch continues to sow confusion for home health agencies served by regional home health intermediary Palmetto GBA. "On payments dated June 5th through June 12th, some providers experienced delays in claims payments due to FISS claim number assignment issues," Palmetto explains on its Web site. "This problem was corrected on June 11th."

However, the fix gave rise to another problem. HHAs were paid for the delayed claims starting June 15 and saw the payment amounts on their remittance advices (RAs). But the claim detail did not show up on the RAs. "This is creating a situation where an amount equal to the total reimbursement amount of the missing claims is appearing in the adjust to balance field," Palmetto explains.

More reconciliation confusion ahead: The FISS contractor hasn't yet fixed this problem, but when it does there will be more confusing RAs. That's because providers will have already received payment and the payment amounts on previous RAs, but the claim detail will show up on current RAs.

"This will again cause an amount equal to the total reimbursement for these claims to appear in the adjust to balance field on the remit," the RHHI warns.

• Medicare's redesigned Provider Statistical and Reimbursement system is making its debut. Medicare's new Internet-based PS&R system at www.cms.hhs.gov/PSRR  will take effect July 13, CMS says in a new MLN Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6519.pdf.

Take note: "Providers will be responsible to obtain their own PS&R Summary Reports needed to file their cost reports for fiscal years ending January 31, 2009 and later," CMS notes on its PS&R site. "Prior to accessing PS&R, each user must first have an ID and password for CMS' Individuals Authorized Access to CMS Computer Systems (IACS)."

Cost reports for years ending prior to Jan. 31, 2009 will still use the legacy PS&R system, CMS notes in the MLN Matters article. Providers can request detail reports via the Internet, but their intermediaries or carriers must still send them securely due to their "sensitive data," CMS notes. CMS continues to permit contractors to charge for more than one detail report per year.

Resource: The transmittal is at www.cms.hhs.gov/transmittals/downloads/R153FM.pdf.

• Confused about when you can bill venipuncture visits and when you can't? Regional home health intermediary Cahaba GBA may be able to help you. Venipuncture is no longer allowed by law as the sole qualifying service for the Medicare home care benefit, Cahaba explains in its July newsletter for providers. But you may bill it as a skilled service if another qualifying service is already present.

For example: "A patient with coronary artery disease was hospitalized with atrial fibrillation and for a fractured femur. Subsequently, the patient was discharged to the home health agency with orders for new anticoagulation therapy and physical therapy needs," Cahaba says in the newsletter. "The qualifying skilled needs for this patient are the physical therapy and the observation/assessment and teaching by the skilled nurse. Venipunctures, as indicated, are necessary to report PT/INR levels to the physician for titration of the anticoagulant therapy."

Bottom line: "These visits are billable, because there are already other qualifying skilled services in the home," Cahaba explains. Venipuncture still must be reasonable and necessary, the intermediary reminds HHAs. That means a physician order associated with a specific symptom or diagnosis and testing frequency within "accepted standards of medical practice."

• Some home care providers are getting a piece of the American Recovery and Reinvestment Act pie.

The Visiting Nurse Association in Aurora, Ill. will receive $1.1 million from the stimulus bill that President Obama signed into law in February, notes Rep. Bill Foster (D-Ill.) in a release. "This funding allows for the renovation of our facility so that we can ultimately serve more patients by utilizing our space in the most efficient manner," says the VNA's Dave Koch in the release. The ARRA grant funds must be used for capital improvements.

In Colorado, the Northwest Colorado Visiting Nurse Association Inc. in Craig will receive nearly $300,000 in ARRA funds, the Associated Press reports.

• Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will join other Medicare contractors in informing beneficiaries about therapy caps. "DME MACs shall update the [Medicare Summary Notice] messages on their claims and provide educational information to help beneficiaries understand therapy caps," CMS says in June 26 Transmittal No. 509 (CR 6497).

Intermediaries and other Medicare contractors got the same marching orders in a February transmittal, CMS notes.

• If you want to increase the flu vaccination rate amongst your employees next flu season, you may learn some effective strategies from a new Joint Commission monograph. "The monograph includes information about seasonal influenza and the influenza vaccine, barriers to successful programs and strategies for overcoming them, and examples of successful initiatives organizations have used to improve their influenza vaccination rates," says the Oakbrook Terrace, Ill.-based accrediting body, formerly known as JCAHO.

Collaborators on the project include the Association for Professionals in Infection Control and Epidemiology, the Centers for Disease Control and Prevention (CDC), and the Society for Healthcare Epidemiology of America.

"Health care worker flu vaccination rates have been less than optimal for years and the vaccination rate is still below 50 percent," says the Commission's Jerod Loeb in a release. "The monograph includes strategies that organizations can employ and provides a foundation to improve vaccination rates."

The monograph is available for free download at www.jointcommission.org.

• Tough economic times are posing a threat to many home health agencies, including those in Ohio. Last year, Ohio's Medicaid program gave HHAs their first rate increase in 11 years. This year, Gov. Ted Strickland (D) is proposing to rescind the 3 percent increase, notes The Columbus Dispatch newspaper.

Charles Bradley of Constance Care Home Healthcare in Circleville already passed that increase onto his 127 employees, he tells the newspaper. "Now what am I going to do?" Home care workers' wages lag behind those of hospital and nursing home workers even before the rollback, Kathleen Anderson of the Ohio Council for Home Care tells the Dispatch.

• Despite the rough economy, home care mergers and acquisitions continue at a healthy pace. Gentiva Health Services Inc. has purchased the assets of Nicholas Webster County Home Health Agency from the Nicholas County Commission on behalf of the Nicholas County Board of Health in West Virginia.

The purchase for undisclosed terms expands Gentiva's coverage in the certificate of need (CON) state to 20 counties, the Melville, N.Y.-based company says in a release.

And High Point, N.C.-based Advanced Home Care has purchased Takoma Regional Home Health Services in Greeneville, Tenn., reports the Triad Business Journal. Takoma is a division of Takoma Regional Hospital and provides skilled services to patients in six counties in northeast Tennessee, the newspaper says. Advanced Home Care will add home medical equipment to Takoma's business lines.