MMA changes may have less effect that providers hoped.
The Centers for Medicare & Medicaid Services expects to finalize its rules on the use of extrapolation shortly, agency staff reported during a recent Open Door Forum.
Providers have long challenged the use of extrapolation - also known as statistical sampling for overpayments - by Medicare contractors.
Under the Medicare Modernization Act, contractors are not permitted to use statistical sampling or extrapolation to calculate an overpayment unless there is a finding of a "sustained or high level of payment error." A similar finding is also required for a contractor to initiate a nonrandom prepayment review based on a provider's or a supplier's identification of an improper billing practice.
However, the exact effect of these MMA provisions will not be clear until CMS decides how it will define "sustained or high level of payment error." In response to a question from Eric Sokol of the Power Mobility Coalition regarding the allowable use of extrapolation, a CMS staffer reported that the agency is updating the Program Integrity Manual instructions on the use of extrapolation. The House and Senate Budget committees have passed their fiscal year 2006 budget resolutions, and they could be bad news for home care providers.
The House committee proposes cutting $20 billion over five years from mandatory spending programs under the Energy and Commerce Committee. The Senate committee proposes cutting $15 billion from mandatory spending programs under the Senate Finance Committee.
Most of those cuts are expected to come from Medicaid's budget. And when lawmakers are searching to meet their goals, Medicare may become an irresistible target for cuts as well.
There's a new billing code for portable oxygen concentrators that also function as stationary units. Suppliers should use HCPCS Code K0671 when billing Medicare for the portable equipment add-on fee for patients using lightweight concentrators that can function as both the patient's stationary and portable equipment, according to CMS.
The new code takes effect April 1. Details are at
www.cms.hhs.gov/manuals/pm_trans/R451CP.pdf.
Don't forget to check out your new patient outcomes figures posted on Home Health Compare. CMS updated the patient stats earlier this month.
CMS is seeking comments on its proposed diabetes demonstration project, which will use "advanced computer and telecommunication technology" to manage the disease, CMS said in the March 4 Federal Register. The agency seeks approval for an extension of the project as it enters its second phase.
Amedisys Inc.'s earnings surged in 2004. The Baton Rouge, LA-based HHA chain reported net income of $20.5 million on revenues of $227.1 million for the year. That compares to an $8.4 million profit on $142.5 million in revenues for 2003.
Amedisys credited the increase to its 13 new locations in 2004, its acquisition of eight [...]
