Home Health & Hospice Week

Home care patients ideally suited for a pharmacist's help, project finds.

If you're looking for an innovative way to cut hospital readmissions, you might want to add a visiting pharmacist to your staff.

In a one-of-a-kind pilot project, the Uni-versity of Minnesota and the Minnesota Visiting Nurse Agency teamed up to send a pharmacist into home care patients' homes to evaluate their medications, reports the Minneapolis-St. Paul Star-Tribune. The university and VNA have made the program permanent after its initial success.

Of 70 patients with complete records in the program, hospitalizations were cut from 32 to 16 and emergency room visits from 16 to eight, reports the pharmacist in the project, Shannon Reidt. Reidt gives patients suggestions to help them comply with their medication regimens. She also recommends drug changes to doctors and makes suggestion to the agency's nurses and family caregivers.

"Sometimes they take the drug wrong or have bad side effects," Reidt tells the Star-Tribune. "And sometimes they just get the wrong drug for their condition."

Reidt targets patients taking nine or more medications for visits. She still works one day a week at the university as an assistant professor and the university and the VNA split the $100,000 cost of the program.

A visiting pharmacist is ideal for home care because patients are on so many medications, Reidt tells the newspaper. Nursing home patients average eight meds while the patients Reidt visits average 18.

• CMS is keeping the heat on home health agencies in South Florida over abuse of outlier payments. The agency suspended payment for 10 HHAs in October over outlier issues, CMS finally officially announced in a Dec. 29 press release.

CMS hasn't suspended any more Miami-area agencies' payments, but it is zeroing in on questionable physician relationships to get at the problem. CMS is "implementing extensive pre- and post-payment review of claims submitted by order-ing/referring physicians" and "validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians," CMS says in the release.

Further, the agency is "verifying the relationship between physicians who order a large number of home health services and the beneficiaries for whom they ordered those services," CMS says.

In person: The agency is also "identifying and visiting high risk beneficiaries to ensure they are appropriately receiving the services for which Medi-care is being billed," according to the release.

• You may have a few more hassles to deal with as CMS tightens up its enrollment procedures. When a contractor denies an enrollment application or revokes billing privileges based on "adverse legal action," it now will search PECOS to see whether the provider or its principal owners and management have any other Medicare entity associations, CMS says in Dec. 19 CR 6097 (Transmittal No. 277). If so, the contractor will initiate revocation procedures for the other providers, too.

Contractors will also be pickier about home health agencies that share the same address. CMS strongly encourages site visits for HHAs listed with the same address as another agency that is already enrolled or in the processing of enrolling in Medi-care, the CR says.

Another thing: Until a change of ownership (CHOW) is complete and the "tie-in notice" issued, contractors should also ignore any requests from the seller to change the payment address, physical address, and/or ownership to that of the new buyers, CMS instructs in the transmittal. Ditto for any requests at all from the buyers.

The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R277PI.pdf

On the other hand: In another transmittal regarding enrollment appeals, CMS may make such appeals easier by instructing contractors to explain the reason for a denial "in sufficient detail to allow the provider or supplier to understand the nature of its deficiencies," according to Dec. 12 CR 6248 (Transmittal No. 275).

The transmittal is at www.cms.hhs.gov/transmittals/downloads/R275PI.pdf

• Providers that have had rough going with Palmetto GBA's customer service department may see better times ahead. In its latest Home Health Coalition Questions and Answers, HHAs complained of being unable to get questions answered and not getting calls back from customer service supervisors since the center moved from Florida to South Carolina.

"The Palmetto GBA Provider Contact Center experienced challenging times over the past year," the RHHI admits in the Q&As. "We are committed to overcoming those challenges." Palmetto has hired four more customer service reps, it says.

• You soon may have a chance to give your two cents about your Medicare contractor's performance.

CMS has selected 30,000 providers to participate in the fourth annual provider satisfaction survey of Medicare fee-for-service contractors. Providers can submit responses via Web site, mail, fax, or phone, the agency says in a release. The survey should take about 20 minutes, CMS estimates.

"The results from previous surveys have enabled CMS to set performance standards for our MACs, who will now be expected to meet a minimum survey score from responding providers," says Acting CMS Administrator Kerry Weems. "This performance standard will give contractors a benchmark to use to compare themselves to other contractors, as well as an individual standard to improve upon year after year."

Regional home health intermediaries generally score among the highest contractors while DME MACs tend to score the lowest. More information about the survey is at www.cms.hhs.gov/MCPSS

• DME suppliers have a few extra months to get into compliance with a new diagnosis coding requirement.

Starting in October 2009, the VMS system will capture and process all diagnosis codes reporting on a DME claim, CMS notes in Dec. 19 CR 6068 (Transmittal No. 420). That date is pushed back from CMS's original July 2009 deadline.

The change comes after a critical report from the U.S. Senate questioning the legitimacy of billions of dollars worth of DME claims due to unrelated diagnoses listed on the claims (see Eli's HCW. Vol. XVII, No. 35, p. 277).

• Get ready to cough up some dough if you're a provider served by Cahaba GBA that isn't organized about your remittance advices (RAs).

Starting Feb. 1, "when a provider requests a copy of a remittance advice (electronic or paper), Cahaba will charge $5.00 for each copy," the RHHI says in its January provider bulletin. "Requests will be completed within 45 business days of receipt."

In the Medicare Claims Processing Manual, CMS allows contractors to charge for duplicate RAs, Cahaba points out in the Newsline. The newsletter is at www.cahabagba.com/rhhi/news/newsletter/200901_rhhi.pdf.

• HHA Rowan Regional Home Health and DME company Rowan Medical Facilities in Rowan County, N.C., are merging with High Point, N.C.-based Advanced Home Care, reports the Salisbury Post.

Prior to the merger, Advanced Home Care had 26 locations in North Carolina, Tennessee, and Virginia, the newspaper notes.

• Eight owners and employees of Detroit HHAs have been indicted on kickback charges related to a patient recruiting scheme, according to Michigan U.S. Attorney Terry Berg.

Rebecca Sharp, owner of recruiting company Continuing Senior Care Co Inc. and Mar-keting & Assessment, allegedly told her employees to phone seniors to offer medical and aide services. "If senior citizens inquired how her staff obtained their names, Sharp's employees told them the information came from Medicare," Berg says in a release.

A doctor employed by Sharp then visited the Medicare beneficiary and prescribed home care services regardless of medical necessity, prosecutors say. "After obtaining patients with Medicare coverage, Sharp referred the individuals to home health care agencies in exchange for a fee," according to the release.

According to the indictment, Sharp claimed she could refer 80 patient names and Medicare numbers per week to an HHA and that she charged a $250 per-patient referral fee. Sharp also claimed she employed doctors willing to sign plans of care regardless of a patient's actual medical needs. Sharp schemed to receive $1.1 million in kickbacks, the authorities say.

HHA owners accused of paying kickbacks to Sharp include Nancy Razalan of New Century Home Health Care Inc. in Madison Heights, Generosa Agustin of Family Care Choice and Services Inc. in Southfield, Kevin Watson of Watson Health Care Inc. in Southfield, Jaqueline Jackson of Superior Home Care Inc. in South-field, Hafiz Anjum of Open Arms Home Care Inc. in Southfield, and Michael Gilliam of Quality Home Health Care Services of Michigan Inc. in Southfield. Administrator Edwin McBeth, formerly of Tender Nursing Home Care in Wixom, is also accused.

No doctors were indicted in the scheme, The Ann Arbor News newspaper points out.