Medicare Compliance & Reimbursement

Slow payment and extra documentation requirements are just a few of the headaches Home health agencies battling managed care tactics probably aren't going to see relief any time soon, said two managed care experts at the National Association for Home Care & Hospice's March on Washington conference this month. As long as the Medicare program continues to pay Medicare Advantage plans at the same or better levels, there will continue to be many plans in the market, attorney Vicki Gottlich with the Center for Medicare Advocacy predicted in an April 7 conference session, "The Future of Private Plans Under the Medicare Program." The number of plans in the future will depend on the payment rates and the administrative requirements, managed care expert Marsha Gold with the Mathematica Policy Research think tank forecasted in the session. That wasn't what the room full of frustrated home care providers hoped to hear. HHA representatives presented a laundry list of problems they deal with every day from Medicare managed care plans. "We all have more things to worry about ... (like) taking care of patients," said conference attendee Norma Goodman, owner and administrator of Infinity Health Services in Cleveland, OH. Professional Healthcare Resources has trouble finding out even basic payment information from managed care plans, said Doug Smith of the Annandale, VA-based agency with eight locations. For instance, whether the plan pays for home care by visit or by episode. A Massachusetts provider complained about plans' increasingly restrictive coverage. For example, two major plans will approve just three visits for an elderly patient with complex care needs, which is "very disappointing and alarming," the rep noted. Congressional solution: "I think this is really cost cutting," Gottlich said. The Center is hearing about similar restrictions in a number of states. HHAs will probably have to turn to their members of Congress for relief from such problems, she suggested. But providers aren't likely to see any legislative action on the matter in this election year, she added. Home care organizations should probably aim for a lobbying push about managed care issues in 2009, once a new president is in place. One change Erik Drennan with Mays Home Care would like to see is a 30-day waiting period before a patient's switch to Medicare Advantage takes effect. That way agencies would have a better shot at actually finding out about the enrollment before furnishing or billing services, said Drennan with the agency that operates in Oklahoma and Texas. Another problem facing agencies involves quality improvement organization appeals, said Laurie Neander with At Home Care in Oneonta, NY. A QIO appeal of a managed care coverage decisions requires "reams of paperwork" from the provider but little effort from [...]