Archive for 'Breaking News'

Durable Medical Equipment Competitive Bidding Deadline Is Less Than a Month Away

Posted on 23. Sep, 2009 by .

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CMS is taking questions in open calls on these dates.

Suppliers waiting for the onset of competitive bidding now have a firm deadline for the program. CMS will begin accepting bids for durable medical equipment in nine metro areas starting Oct. 21, CMS’s Competitive Bidding Implementation Contractor said on its Web site.

The bid window will be open for 60 days, and CMS will announce the bid rates and begin contracting with suppliers in June of next year, the CBIC said. The program will go into effect in January 2011. Suppliers can begin signing up for bid system user IDs and passwords on Aug. 17, according to CMS estimates. (more…)

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OIG Finds Startling 82 Percent Error Rate in Hospice Billing, Accounting for $1.8 Billion

Posted on 16. Sep, 2009 by .

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Plus, 2 field-tested steps your hospice can take to ward off audits.

The OIG thoroughly examined hospice care payments — and didn’t like what it found.

A new OIG study focused on hospice claims for beneficiaries in nursing facilities in 2006, for which the OIG reviewed medical records and random samplings of hospice claims. The result was the Sept. 8 report, “Medicare Hospice Care for Beneficiaries in Nursing Facilities: Compliance With Medicare Coverage Requirements.

Outcome: The OIG found that “82 percent of hospice claims for nursing facility beneficiaries did not meet at least one Medicare coverage requirement pertaining to election statements, plans of care, services or certifications of terminal illness,” the report indicated.

In addition, the OIG found that 63 percent of the claims did not meet plan of care requirements. Although meeting these requirements may seem like a no-brainer to many hospice administrators, others struggle to keep up. The key to ensuring you meet Medicare’s requirements, however, is to designate one or more departments to double-check plan of care requirements before you submit your bill to Medicare. (more…)

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‘Ignorance’ Is No Excuse For Home Health Certification Violations

Posted on 09. Sep, 2009 by .

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Here’s how one agency’s lack of due diligence put it on regulators’ bad side.

If you aren’t sure whether your subsidiaries and new acquisitions are following the rules, now’s the time to find out. Unfortunately, an Ohio home care agency is learning that lesson the hard way.

Viaquest Home Health has reached a settlement with the New Jersey Division of Consumer Affairs to stop placing uncertified home care aides with patients or employers who need help from a certified aide, according to the Asbury Park Press.

The agreement comes after an investigation into Viaquest Home Health LLC of Toms River. Viaquest made no admission of liability and admitted that it did not thoroughly examine the Toms River location when it was purchased in 2007, president and CEO Richard Johnson told the AAP. (more…)

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Watch Out For Identity Thieves In Your HHA

Posted on 02. Sep, 2009 by .

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Here’s how one agency acted quickly to protect its client’s privacy.

If you think your patients’ confidential identity information is always safe in your staffers’ hands, think again.

The Minnesota Department of Health’s Office of Health Facility Complaints (OHFC) has substantiated a complaint against a St. Paul home health aide accused of using her patient’s identity to open a line of credit, KSTP channel 5 news reports.

The aide’s employer, Home Instead Senior Care of Coon Rapids, first caught wind of the scam when one of its clients received a credit card he never applied for. He contacted his bank and began the process of tracing how his credit was being used.

During that time, the aide attempted to pay a $572.26 cell phone bill using the illegal card.

Aide’s excuse: The aide first attempted to avoid criminal charges by claiming that the client wanted to take over her cell phone contract. When that didn’t work, she changed her story, saying the attempted charge was for new wheels for the client’s scooter. However, neither story checked out. Home Instead asked the OFHC to investigate the case and is working with authorities to properly penalize the aide, and protect their client’s private information.

© Home Care Week.

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Look For These HCPCS Codes To Pull Audits

Posted on 26. Aug, 2009 by .

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If your HHA provides pressure reducing supplies to help patients with decubitus ulcers, get ready for some audit scrutiny ahead.

Inappropriate Medicare payments for pressure reducing support surfaces amounted to about $33 million for these items during the first half of 2007 alone, according to a new OIG report.

The review found that 38 percent of the claims were undocumented, 22 percent were medically unnecessary, 17 percent had insufficient documentation, and 3 percent had other billing errors. Particularly problematic according to the report? Pressure reducing supplies in Group 2.

For a list of HCPCS codes likely to raise red flags, read more about the report at HC Compliance Essentials.

AUDIO: Got therapy documentation issues? Cindy Krafft can help.

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Arthritis Kits? A Texas HEAT Update

Posted on 19. Aug, 2009 by .

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If your HHA provides DME (such as scooters and power wheelchairs), DME supplies (such as inhalers and nebulizers) or enteral feeding supplies, there’s more reason than ever for your claims to be squeaky clean. The Medicare Fraud Strike Force (HEAT) is looking hard at your claims.

If your HHA is near an urban medical center, chances increase that the feds are data mining your claims to look for improper billing. Why? In an effort to blend in and stay under the radar, Medicare fraudsters tend to operate in large, urban areas where lots of legitimate health care services are being provided. Federal fraud hunters are onto this criminal tactic, so they’re scrutinizing ALL claims from urban areas like Houston, Miami and Detroit because they know the potential is greatest there for recovering defrauded funds.

According to a HEAT fact sheet, 32 Texas providers have been indicted for submitting $16 million in fraudulent claims for DME equipment and supplies, including something called “arthritis kits” (orthotic braces and heat pads). The DME was never delivered or was medically unnecessary, federal prosecutors allege. In some cases, Medicare benes listed on the claims had already died.

HEAT’s case summary lists the agencies, owners and employees involved in the indictments. Included are the usual suspects who obtained Medicare beneficiaries’ PHI. Also indicted are a couple of delivery drivers who simply transported the DME.

New on MP3 or CD: Attorney Robert Markette teaches you how to handle fraud, whistleblowers and qui tam actions before FCA does.

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The Home Care Provider’s Guide to Health Reform Legislation

Posted on 06. Jul, 2009 by .

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Home care could be in for some big budget cuts.

The outcome of the health care reform debate on Capitol Hill is still far from certain, but home care providers are doing their darndest to make sure they aren’t slighted in forthcoming legislation.

Senate lawmakers had hoped to have a health care reform bill proposed before July 4th recess, but lawmakers – both between and in the same parties – haven’t yet come to agreement on legislation.

One change out of Washington that’s sure to happen is OASIS C. Train your staff now for one low price.

Three committees in the House have already released their bill, which represents the views of Democratic members. And the Senate Health, Education, Labor, and Pension (HELP) Committee released its ideas in a series of whitepapers and is in the process of marking up its bill.

The Senate Finance Committee, which is working with a bipartisan group of senators led by Chair Max Baucus (D-Mont.) and Ranking Member Charles Grassley (R-Iowa), hasn’t been able to come to agreement yet on its health care reform bill, although Baucus did recently celebrate that its overall cost was less than $1 trillion over 10 years as scored by the Congressional Budget Office. Many observers expect the bipartisan approach from Senate Finance to have the best chance of ultimate overall passage.

The House draft is the most punishing so far for home care providers, notes the National Association for Home Care & Hospice. It adopts all of the home health agency and hospice cuts the Medicare Payment Advisory Commission has proposed for the industry. (more…)

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Home Health ICD-9 2010 Quick Start Guide

Posted on 29. May, 2009 by .

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Effective Oct. 1 2009, it’s out with the old, in with the new.

CMS has issued 141 new diagnosis codes for you to use starting Oct. 1. Here’s the heads up on ICD-9 code changes home care coders & billers should be paying closest attention to. Plus, we’ve got the link that gets you to the government’s official list of new codes, pronto. 

Most of the new codes offer additional specificity to existing diseases, which can help you code more accurately. You’ll find new codes in most categories, ranging from oncology (such as the 209.31-209.36 series, Merkel cell carcinoma) to orthopedics (813.46-813.47, Torus fracture).

AUDIO TRAINING EVENT: Which of the new and revised diagnosis codes are likely to be case mix codes? How can you earn additional payment under Medicare PPS? Judy Adams’ ICD-9 update for 2010 answers these questions and more.

You’ll also find an expansion of the 799.2 (Nervousness) section, with new codes for irritability (799.22), impulsiveness (799.23), and demoralization and apathy (799.25), among others.

New specificity for late effects

“The new fifth digit ICD-9 codes can be used to report emotional and/or behavioral symptoms,” says coding expert Marvel Hammer. “If these symptoms are associated as a late effect to a traumatic brain injury (TBI), the new ICD-9 code(s) could be paired with the appropriate late effect code, 905.0 (Late effect of fracture of skull and face bones) or 907.0 (Late effect of intracranial injury …).” (more…)

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