News From Home Care
News From Home Care
HCFA capitulates on homebound status
The Health Care Financing Administration (HCFA) has issued a program memorandum instructing its intermediaries to grant favorable appeal decisions regarding the homebound status of beneficiaries unless there has been a change in the patient’s condition.
Home care’s largest trade organization, the Washington, DC-based National Association of Home Care (NAHC), declared the memo a victory and characterized it as HCFA’s attempt to settle a lawsuit, O’Neal vs. Shalala, involving homebound patients. The 1998 suit challenged HCFA’s application of the definition of homebound. In the lawsuit, several beneficiaries won favorable appellate decisions from administrative law judges only to have the intermediary reject subsequent claims for payment.
Under the new policy, intermediaries must take several steps to effectuate a favorable final appellate decision that a beneficiary is "confined to home" rendered on or after July 1, NAHC says.
In addition to paying the claim that was subject to favorable financial appellate decision, the intermediary must promptly pay or review all claims that have been denied or that are property pending in any stage of the appeals process; all claims that have been denied where the time appeal has not lapsed; and all future claims submitted for this beneficiary. Any claim that could be reopened must be done during the 12-month grace period, which begins in July.
According to NAHC, the policy change is the first time HCFA has ever formally allowed a prospective effect to a favorable appellate decision.
"Generally, HCFA has not acquiesced in favorable appellate decisions, requiring both patients and providers to pursue repeated appeals on the same issues," a NAHC spokesperson says.
Research firm predicts home health revenue
Consistent sustained growth expected
Total home health revenue is expected to rise to $44.6 billion this year and to $54.3 billion by 2004, according to a report by the San Jose, CA-based market research firm Frost & Sullivan.
The firm says the four main revenue-generating segments of the home care industry — respiratory products, infusion pumps, and labor/ nursing services — are all projected to experience consistent sustained growth, but at somewhat different rates.
Total revenue for home care respiratory products last year was pegged at $609 million, but was expected to grow at a compounded rate of 8.4%. The three major factors driving growth are an aging population causing an increase in incidence of respiratory disorders, more aggressive medical treatments creating higher incidence of respiratory failure, and increased portability of devices allowing wider applications.
On the other hand
Frost & Sullivan also points to three factors that will restrain growth in respiratory products:
1. Cuts in oxygen reimbursement reducing demand for therapy devices.
2. An unclear ruling on new criteria for reimbursement creating confusion among suppliers.
3. A focus on disease prevention that might reduce incidence of respiratory disease.
Total revenues in the home health infusion pumps market in 1999 were estimated at $195 million, the firm’s report says. It predicted a compounded growth rate of 9.9% through 2006.
Market drivers in this area include the expansion of pain management, which will help drive home health infusion therapy, and advances in telemedicine, which will enable more care to be provided in patients’ homes rather than in hospitals.
Factors that could restrain growth in the home health infusion market include unfavorable reimbursement conditions, possibly discouraging patients from using home health infusion therapy, and safety concerns that will require additional investment in product development.
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