Prospective Payment System:
CMS FORGES AHEAD WITH 2006 PAY INCREASE FOR HHAs
Published on Thu Jan 05, 2006
But don't count on the extra money yet.
Good news: Even though both the U.S. House and Senate have voted to freeze Medicare payment rates for home health agencies this year, you should be seeing a nearly 3 percent increase in your reimbursement.
That's because 2006 budget legislation ap-proved by both houses of Congress still has to be approved by the House again before going on to the President to sign into law (see Eli's HCW, Vol. XIV, No. 45). And the House isn't expected to come back in session until the end of this month.
The budget package's pending status means the Centers for Medicare & Medicaid Services is moving ahead with the 2.8 percent increase to HHA payments as scheduled, a CMS official tells Eli.
"Medicare systems are currently programmed to pay RAPs or claims with 'Through' dates on or after Jan.1, 2006, as the final rule describes," says the CMS staffer, referring to the rule published in the Nov. 9 Federal Register (see Eli's HCW, Vol. XIV, No. 40). "We're not holding off any changes required by current law," the source adds.
Beware: Don't bank on the increased reimbursement rates quite yet, even if they're showing up in your Medicare reimbursement checks. If the budget bill passes as is, the National Association for Home Care & Hospice expects "CMS will have to make retroactive adjustments to payments to account for the market basket and [5 percent] rural add-on changes," the trade group tells its members. That means for non-rural HHAs, Medicare will reach back into your wallet for the money it already has started paying you.
"We're looking at contingency plans so that we can react quickly if the pending legislation is enacted," confirms the CMS official.
To be safe, NAHC advises its members budget "under the assumption that the market basket freeze for calendar year 2006 will occur," it says. NAHC and other industry trade groups have vowed to fight the freeze when the budget package returns to the House. Mind Your Decimal Points In the meantime, HHAs should beware a possible claims system snafu that could make their billing incorrect, regional home health intermediary Palmetto GBA warns in a posting on its Web site.
Providers using the Direct Data Entry (DDE) electronic claims system must key in three digits after the decimal point on their claims' dollar amounts, Palmetto instructs. "If providers do not key all three digits, then the Fiscal Intermediary Shared System (FISS) system will adjust the amount," the RHHI warns.
Example: If a provider keys 119.00 when it enters the FISS system, then the system will move the decimal to reflect 11.900. Until a fix comes, "the provider must key 119.000 so the system will reflect the correct amount of $119.00," [...]
