Saturday, July 31, 2010

Part I: Preparing for Audits - ZPIC Audits

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739

The Centers for Medicare and Medicaid Services (CMS) are now conducting ZPIC audits. ZPIC’s are conducted by Zone Program Integrity Contractors. Unlike RAC audits that target identification of overpayment and CERT audits that attempt to pinpoint improper payments, ZPIC audits focus on fraud in the Medicare Program. This means that ZPIC contractors can audit the integrity of all Medicare claims, both pre- and post-payment.

CMS has established seven ZPIC zones. Contracts have been awarded in three zones thus far, as follows:

 Zone 5 – AdvanceMed: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia
 Zone 7 – SafeGuard Services: Florida, Puerto Rico, and the Virgin Islands
 Zone 4 – Health Integrity: Texas, Colorado, New Mexico, and Oklahoma

ZPIC contractors are currently especially active in Zone 4.

Thursday, July 22, 2010

Action Alert :

Please encourage your congressional legislators to add their names as cosponsors of the Home Health Care Access Protection Act (H.R. 5803; S. 3315) introduced by Reps. Jim McGovern (D-MA) and Walter Jones (R-NC) and Sens. Susan Collins (R-ME) and Russ Feingold (D-WI). Go to NAHC Report, 7/15/10 for more information about this bill.

In light of the recent CMS rule that proposes to cut home health payments by 3.79 percent in 2010 and 3.79 in 2011 based on an unfounded allegation of "case mix creep" (NAHC Report, 7/19/10), this legislation is vitally important to preserve access to home health services because it would establish a fairer and more transparent process for evaluating case mix changes. Home health advocates also should ask their legislators to convey these significant concerns about payment cuts to CMS.

Click here and enter your zip code to find your federal legislators and their contact information. To access the text of the House bill and a list of House cosponsors, click here. To see the text of the Senate bill and a list of Senate cosponsors, click here. If your legislators have not yet cosponsored H.R. 5803 or S. 3315, please contact their offices and encourage them to do so. When calling, ask to speak with the staffer who handles Medicare issues. For talking points, click here.

To send an email on this issue to your members of Congress using the NAHC Legislative Action Network, click here. We encourage you to edit the sample email provided there by adding information about your own background and experience and the impact these payment cuts could have on home health patients in your state.

Tuesday, July 13, 2010

Join us for Upcoming Events

Over the next several months, Daymarck will be at industry shows where we hope to meet you, learn more about your home health agency, and tell you more about how we can make your home care coding as easy and pain-free as possible.

Tomorrow July, 14 we will be attending the NAHC and HHFMA 16th Annual Financial Management Conference & Exposition at the Sheraton Chicago Hotel & Towels. At a NAHC Conference, be sure to participate in user groups meetings, client appreciate receptions, in-booth educational sessions and more.
Nick and George will be at Booth # 301 so stop by for a free cost analysis and don't forget to pick up a calculator. If you are not able to attend, follow @Daymarck during the event for updates.

For the second year in a row, we are sponsors of Decision Health's Home Health Coding Summit at Loews Philadelphia Hotel August 8-12 to join expert coders and network with your peers while participating in an exclusive day of interactive, advanced-level coding and celebration of 2,010 certified coders in 2010! Plus new in 2010: Procedure coding — a new requirement for home health agencies — along with OASIS-C and coding interactions. In addition to being an exhibitor hosting a booth, we will be sponsoring the luncheon session where we are gathering thought leaders in a panel discussion. Stay tuned for more details.

Last, but not least, mark your calenders for October 2-6! Daymarck will be at the 2010 National Association for Home Care & Hospice 29th Annual Meeting & Exposition in Dallas, TX. 

Feel free to reach out to us at anytime with questions. We look forward to seeing you at all of the upcoming events!

Friday, July 9, 2010

Changes in Referral Relationships with Physicians

Elizabeth E. Hogue, Esq.
Office: 877-871-4062
Fax: 877-871-9739

Significant changes are likely in the near future in relationships between providers and referring physicians. Trade associations, for example, are providing substantial guidance for their members on this subject. PhRMA, a trade association whose members are pharmaceutical research and biotechnology companies, recently updated its Marketing Code. The revised Code was applicable as of January 1, 2009. Although the Code applies only to members of PhRMA who voluntarily agree to follow it, the Code has helped providers to understand changing standards regarding acceptable marketing practices.

With regard to taking lunches to physicians’ offices, for example, the revised Code says that PhRMA members who elect to adhere to the Code may present information to healthcare professionals and their staff members during the workday, including at mealtimes. In connection with such presentations or discussions, the Code also says that it is appropriate for occasional meals to be offered as a business courtesy to the participants. The presentations must, however, provide scientific or educational value and meals must meet the following standards:

- Modest, by local standards;

- Not part of an entertainment or recreational event;

- Provided in a manner conducive to informational communication; and
- Limited to in-office or in-hospital settings.

Federal regulators have been active for many years in oversight and monitoring of referral arrangements with physicians and will surely continue to do so. The bases for these activities include the federal anti-kickback statute and the so-called Stark laws. Many states have enacted statutes and implemented regulations governing referrals.

State courts have also addressed these issues. In Sloan v. South Carolina Board of Physical Therapy Examiners, No. 26209 (S.C. Sept. 25, 2006), for example, the Supreme Court concluded that a state statute prohibits physical therapists from being employed by physicians who refer patients to them for therapy services. The Court also specifically recognized the right of the state’s Board of Physical Therapy Examiners to enforce the statute against therapists who violate it.

Recent activity seems to indicate that state legislatures and licensure boards are likely to further regulate these relationships even more aggressively. State licensure boards in New Jersey, for example, may require physicians to refuse lunches provided by representatives of pharmaceutical manufacturers. Physicians may also be required to disclose payments of more then $200.00 as a condition of licensure.

There seems to be a perception among state governments that federal regulation of relationships between physicians and providers who receive referrals from them has been ineffective. Consequently, state regulation is likely to become more extensive and frequent. Stay tuned for more information about this important trend.

©Copyright, 2010. Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.