News from Home Care

HCFA rescinds sequential billing, payment policies

The practice of withholding a patient’s claim until Medicare has paid the previous month’s claim has ended. The Health Care Financing Administration (HCFA) has instructed its fiscal intermediaries to discontinue sequential billing and payment policies for home health claims effective July 1.

The memorandum released by HCFA in April instructed fiscal intermediaries to remove all edits from their claims processing system and to process all claims, despite the absence of a previous month’s claim.

"We’re glad the industry was able to make Congress realize that sequential billing was putting the squeeze on the industry, said Scott Lara, a spokesman for the Jacksonville, FL-based Home Care Association of America.

However, Lara points out that the revocation of sequential billing takes place on the same day 15-minute incremental billing begins. Under the Balanced Budget Act, home care agencies will be required to include a code that will identify the length of each visit in 15-minute increments.

Home oxygen suppliers unfazed by GAO report

Despite a General Accounting Office report submitted recently to Congress that is critical of home oxygen providers, the industry says it has little to fear if the Health Care Financing Administration (HCFA) issues new standards to ensure patient access to home oxygen.

"It’s about time that HCFA got around to issuing standards for home oxygen suppliers," says Erin Bush, associate director of government relations for the Health Industry Distributors Association in Alexandria, VA. "We have been working toward more realistic standards ever since we held a consensus conference on this issue in 1996."

The GAO study concluded that HCFA has failed to take steps to ensure access to home oxygen, and it recommended that HCFA monitor trends in beneficiary access to various types of home oxygen equipment, restructure the modality-neutral payment, and educate physicians on their right to specify the home oxygen systems.

The GAO also called upon HCFA to establish service standards for Medicare’s home oxygen benefit and chastised the agency for not having met this requirement. HCFA has been unable to come up with standards for the home oxygen industry because it has spent much of its resources dealing with other pressing matters, such as year 2000 computer problems.

HCFA, however, has promised to issue standards that would apply to all durable medical equipment within the next few months.

NHO offers grief counseling

In the wake of April’s shootings at Columbine High School in Littleton, CO, the National Hospice Organization (NHO) is offering to provide grief counselors to schools and communities struggling to make sense of the shootings that left 15 people dead, including the two teenage assailants.

"As school administrators and civic leaders grapple with how to talk about this tragedy and help people who may be frightened, confused and in pain, hospices offer grief and counseling support at no cost," says Karen Davie, NHO president. "We simply want to make local hospice grief experts available wherever they are needed."

The NHO stressed the expertise that hospices have in grief counseling and pointed out that they are also trained to provide grief counseling following community tragedies.

"Whenever there is a situation where people need our help, we want to be there to lend a hand," Davie says. "Whether it is in Colorado or elsewhere, hospices are committed to making sure that its bereavement services are available for all who need them."

HFA brochures offer help for dealing with grief

The Hospice Foundation of America (HFA) has released a series of educational brochures to help people deal with grief better in the workplace, at school, and in worship communities.

The Living with Grief series, which includes Living with Grief: At Work; Living with Grief: At School and Living with Grief: At Worship was developed in conjunction with HFA’s annual national bereavement teleconference, Living with Grief: At Work, At School, At Worship, which was broadcast to more than 2,300 communities in April.

The brochure series offers straightforward advice and basic guidelines for dealing with grief. For example, the At Work brochures addresses situations involving a co-worker who has been diagnosed with a terminal illness and how employees can cope with the news. It illustrates grief from the different perspectives of the diagnosed employee, his co-worker and his supervisor.

The brochures were written by Kenneth Doka, PhD, senior consultant to the HFA. They were written for the layperson but are targeted to hospices conducting community outreach programs and community education.

To order the brochures, which cost 50 cents per copy, call HFA at (202) 638-5419 or order via HFA’s Web site at

Faxed CMNs can initiate payment

The Health Care Financing Administration now says durable medical equipment suppliers can use faxed certificates of medical necessity (CMNs) to initiate billing to the Medicare program as long as the original documentation is maintained.

In addition, HCFA has instructed durable medical equipment regional carriers (DMERCs) to lift any restrictions that prohibit suppliers from communicating with physicians using cover letters. Cover letters had been the source of confusion when one DMERC restricted their use last year.

According to HCFA, a written order must be sufficiently detailed and must include the patient’s name, a description of the item, a physician’s signature, and all options and additional features. Also, the date on the written order of the CMN should be the date on which the physician signed the written order.