Home Health & Hospice Week

QIOs To Disclose More to Patients


Health care providers should be aware that patients will now be able to extract potentially damaging information from QIOs. If a patient ever complains to a quality improvement organization, the Medicare QIO must tell her, at a minimum, whether the QIO believes the beneficiary's treatment met "professionally recognized standards of health care," the U.S. Court of Appeals for the D.C. Circuit ruled June 23 in Public Citizen Inc. v. Dep't of Health and Human Services (No. 01-5294). The appellate panel was construing a provision of the Social Security Act stating that a QIO - previously known as a peer review organization - "shall inform the individual (or representative) of the organization's final disposition of the complaint." Following the Centers for Medicare & Medicaid Services manual, QIOs currently tell beneficiaries only that their complaint has been received and examined and that the QIO will take unspecified appropriate action if warranted. "To single people out, to make it more likely that they will be sued or punished, to damage the relationship that they have with their patients and their peers, is an antiquated notion that doesn't hold water anymore," says American Health Quality Association Executive Vice President David Schulke. Home health agencies must cover three additional codes under the prospective payment system's bundling of supplies, but the Centers for Medicare & Medicaid Services also is taking two codes off the list. Beginning Oct. 1, agencies and suppliers will not be paid separately for codes K0614 (chem/antiseptic solution, 8oz), K0620 (tubular elastic dressing), or K0621 (gauze, non-impreg pack strip) when patients are under a home health plan of care, CMS says in July 3 program memorandum AB-03-096. Coming off the bundling list are A4421 (Ostomy Supply misc) and 97014 (Electric stimulation therapy). The updates are due to changes in the coding system, not changes to what items are covered, CMS insists. Hospices now will experience the same sharing of information that home health agencies already have when overlapping claims occur. Regional home health intermediaries can share hospice contact information with other hospices and/or institutional providers to resolve billing conflicts for overlapping claims, CMS says in June 27 program memo A-03-055. Health care providers got another reprieve on a much maligned reimbursement policy June 30. The implementation of the $1,590 cap on Part B outpatient therapy services is postponed from July 1 to Sept. 1, CMS advised fiscal intermediaries and carriers in July 3 program memorandum AB-03-097. The move was sparked by a lawsuit filed by the American Parkinson Disease Association, Easter Seals and the Medicare Rights Center, all of whom oppose the cap. Providers are now looking to Congress to pass legislation eliminating the cap, which affects home [...]