Reimbursement:
PRRB SHOOTS DOWN TRAVEL COSTS
Published on Mon Jan 23, 2006
PT salaries, IV drugs also addressed in cost report decision.
If you think an hour commute is too long, you may get an argument from Medicare.
Oklahoma-based Professional Home Care Inc. learned that lesson the hard way when the Provider Reimbursement Review Board handed down a decision costing the home health agency more than $84,000 for cost report years 1995 to 1998.
The HHA claimed mileage and overnight hotel costs for its owner and CEO to travel from Profession-al's home office outside Oklahoma City to its location in Pauls Valley, 45 miles away, according to the decision issued last Nov. 18. The CEO claimed travel costs for 45 weeks in 1995 and 23 weeks in 1996, the Board notes.
Regional home health intermediary Cahaba GBA disallowed the travel and hotel costs, saying the mileage was a non-reimbursable commuting cost and "it was not prudent for the CEO to incur hotel expenses when staying in a town within a reasonable driving distance from his residence."
Professional argued that it wasn't reasonable or necessary for the CEO to return home each night, but the intermediary countered that the CEO often drove back and forth between the Pauls Valley location and home office multiple times per day.
Daily commute: The Board upheld the disallowances, agreeing that the 45-mile distance between the two locations was normal commuting distance. Plus the Board didn't "find adequate justification for the CEO to visit the Pauls Valley facility on an almost daily basis, almost every week, when his purported work site is in the corporate home office," it says.
Cahaba's argument for the travel costs disallowance is somewhat contradictory, notes attorney Joel Hamme with Powers Pyles Sutter & Verville in Washington, DC.
On one hand, Cahaba "insisted that the CEO was supposed to be working in the home office rather than at the facility and that the CEO was spending too much time at the facility," Hamme points out. On the other hand, "if the CEO was not based at the facility, then at least some of the mileage for whatever trips were reasonable should have been an allowable travel cost because this was not a commute-to-work situation."
"The travel decision is flawed," maintains consultant Jim Hamilton with David-James in Baltimore. "The mileage is allowable if the trips emanated from the home office," since the personal travel is from home to the first site. "If the CEO went from home to the central office and then to the other agency, then the mileage from the home office to the agency is allowable." Pick Your Poison--Or Your RHHI Will Professional also struck out in its argument against a $66,000 disallowance related to home infusion drugs. The HHA billed Medicare patients directly for home infusion drugs while billing [...]
