Having 30-plus customers online before its first anniversary celebration is a headline in itself. Vice president of sales and marketing Brad Caldwell attributes the Atlanta-based company’s early success to a unique pricing model, based on a percentage of revenue rather than per-seat licensing.

A company news release indicates that ContinuLink rolled out a real-time PECOS support tool, offering cross-verification of provider names, on June 28, four days after CMS released its new PECOS regulation. Without leaving the ContinuLink application, customers are now able to see whether their referring physicians have registered with the PECOS database.

“ContinuLink believes we were the first system in the country to have integrated real-time PECOS support with cross verification of provider name with NPI and PECOS files to assure claims are not rejected incorrectly,” Caldwell said.

ContinuLink CEO Satish Movva added, “This highlights the strength of using a centrally hosted, web-based system, where updates and system enhancements can be rapidly and seamlessly rolled out without user intervention and without service interruption.”

We spoke with Terri Santangelo, RN, BSN, VP of Clinical Operations with ContinuLink’s newest client, FirstLantic Healthcare, Inc. in Delray Beach, Florida. Ask if her agency was struggling with PECOS, Santangelo could only manage a restrained “Ugh!” but said she is looking forward to getting through training and going live on October 1 and beginning to use the new vendor’s PECOS lookup feature.

In addition to the PECOS enrollment and physician name cross verification, ContinuLink also enhanced the system to automatically take pending enrollments into account. On June 30, additional functionality was added to give real time verification of new physicians as new referrals or physicians were entered into the system.

The machine readable file for this initiative became available to software developers June 24. Following complaints from the AMA, the PECOS deadline and scope of claims marked for payment denial has changed numerous times since December, 2008. (see Sidebar: “PECOS History”)

One ContinuLink customer, Sarah Ahmed of Fresno, California, noted her vendor’s foresight, stating, “We came in on Monday morning thinking, as most home care providers did, that we would have to start manually checking each referring physician by hand but we found that all of our physicians were already checked for PECOS eligibility by name and NPI.”

About Continulink

ContinuLink provides a hosted, “Software as a Service” (SaaS) application for home health care, hospice, private duty and supplemental medical staffing businesses. The company was incorporated in Delaware on July 20, 2009 and is owned by Sentinel Capital Partners of NYC. Interim Healthcare remains its largest customer.

www.continulink.com

Most of them face a PC lifecycle management (PCLM) environment that struggles to incorporate the needs of mobile workers who range much farther than the most distant patient home. They handle telecommuters whom they never see and international sales teams whom they know of by reputation only. Their day-to-day PCLM effort encompasses financial inefficiencies, compliance risks and security consequences that can result in challenges like yours but on a grander scale.

They have learned:

• Inventorying tools are dependent on a connection to the corporate network
• Manual data collection processes are inconsistent
• Inventory collection agents are often tampered with by your own employees
• Data collection methods are fragmented and dispersed

To do their job more effectively and report improvements to management in an easily understood way, do what they do. Adopt a PCLM approach that reflects the realities of mobile computing in home care:

• Use tools that track assets via the internet, independent of network connection type
• Automate data collection to automatically collect ‘who, what, where’ information
• Use firmware-embedded inventorying agents to avoid tampering
• Centralize data views via an online interface or online portal with plug-ins
• Utilize software-as-a-service solutions for scalability and cost-efficiency

Putting such a plan in place will help achieve increased auditing accuracy, improved compliance, enhanced security and substantial cost savings. In times like these, saving money, doing more with less and protecting your agency’s reputation can make heroes of the agency IT staff.

Here are some further insights based on research by one of the technology world’s leading mobile security firms, Absolute Software. Admittedly, they have an ax to grind and a product to sell. Nevertheless, the white paper from which this plan is devised offers sound recommendations.

PC Lifecycle Management

PCLM enables efficient and cost-effective management of computing assets – including hardware and software – throughout their lifecycle. Sound PCLM programs are invaluable to technology planning and procurement and, when effectively implemented, improve productivity, enhance performance and maximize cost efficiency.

At its foundation, PCLM requires accurate inventory of all of your agency’s computing assets. In an agency where point-of-care has been deployed, this becomes more difficult to accomplish. Clinicians’ devices rarely appear within the office. Still, your accurate inventory requires full visibility not only into devices connected by wires but also to the mobile machines beyond your physical control.

Limitations of inventory tools

The most common PCLM tools rely on a discovery agent to supply inventory data. If a device is not connected when the inventory is run, data will not be captured and reported. Policies intended to encourage network connection at scheduled times are difficult to enforce.

A recent survey of 156 IT professionals by Info-Tech Research Group found that, at any given time, they are able to track 68% of their assets. Thus, 90% of survey respondents concur that off-network tracking capabilities are essential but only 34% expressed satisfaction with their vendor’s ability to track off-network devices.1

Limitations of employee-controlled data collection

To bridge the gaps left open by inventory tools, some IT managers decide to use some kind of manual process. This allocates responsibility to individual employees, who, among other tasks, must supervise machine movement, detect missing or misplaced assets, monitor upgrades and installments, and regularly record and report asset status.

Imagine for a moment the reaction of overworked nurses asked to perform IT tasks. Time intensive and inefficient, manual solutions are prone to the inaccuracies and inconsistencies characteristic of human input. Even the willing manual recorder will commit common mistakes. A busy clinician can delay the documentation process while a negligent one can forgo it all together.

Issues with consistent documentation are compounded by mobile computers’ tendency to switch hands from time to time, changes that manual records can be slow to reflect. A majority of Info-Tech survey respondents, 79%, said that inconsistent manual processes prevented them from achieving optimum auditing accuracy. 46% found it challenging to manage software patches and updates.

Some beleaguered CIOs resort to the shotgun approach, deploying multiple inventory system in the hopes that aggregated data will equate to complete data. Tools include:

• enterprise asset management systems (85% of survey respondents)
• automated discovery system (54%)
• barcode scanner (51%)
• maintain a log book (48%)
• radio frequency identification (37%)

Multiple costs of inaccuracy

With an inaccurate account of inventory comes an inability to effectively plan for procurement, upgrades, migration and retirement. Poor visibility makes it difficult to identify and perform proactive maintenance tasks, compromising machines’ optimal life span. This translates into high replacement costs, ineffective allocation, inefficient purchasing and ultimately, unnecessary expense.

Mobile computers also increase the incidence of loss and theft. Consider that factors such as lost productivity, replacement and data breach costs mean a missing device runs an organization $49,246 on average.2 Add to that the fact that 92% of IT security practitioners who participated in a recent Ponemon Institute survey stated that someone in their organization has had a laptop lost or stolen, with 71% adding that this loss resulted in breached data.3

Unmonitored use also allows for unauthorized activities to go undetected, posing risk to both the individual machine and the entire fleet should the device introduce hazardous items to the network.With such severe consequences of poor mobile management, you may be tempted to run for cover but implementing a cost-effective, preventive solution is the IT department’s opportunity to shine.

Key PCLM elements in a mobile environment

There are technologies that can track devices on or off the network. This may be where Absolute Software’s white paper becomes self-promotional but resist letting that turn you off. It is a decent solution but you can always shop for their competitors.

The recommended systems collect asset information via an Internet connection whenever a remote machine connects, not only at designated times scheduled by IT staff. Some incorporate geo-location tracking: using GPS or WiFi to pinpoint machine location on a digital map — or geo-fencing: defining device boundaries which trigger alerts should a device cross them. These additional features help identify suspicious circumstances, more easily determine if a computer is lost or stolen and more quickly locate machines for basic maintenance tasks. The better ones extend their reach to PDAs and smart phones as well.

To prevent employee tampering with software tracking applications, acquire one with a firmware-embedded agent. Asset tracking agents that are embedded in PC firmware, usually the BIOS, at the point of manufacture are the most tamper-resistant solutions available. Such software is highly resistant to unintentional or deliberate meddling as an embedded agent can continue to report asset information even if an OS is re-imaged, or the hard drive reformatted or replaced. Regardless of whether a device is within your physical control, tampering can be prevented and uninterrupted asset reporting ensured.

Other recommendations include:

• Automate asset data collection as much as possible, avoiding manual processes that rely on employee diligence, technical expertise and consistency.
• Centralize inventory data with an online interface. Aggregate fragmented data into one, easily managed location.
• Utilize SaaS to minimize infrastructure and maintenance costs, for all the same reasons you do your banking online: simple to implement and scalable as your needs change.

Benefits of PCLM best practices

Improved planning: Systems that inventory assets regardless of their physical location and that do so automatically without end-user reliance can consistently achieve over 99% accurate inventory data. This is the data you want to use to forecast your refresh cycle. Accurate inventories:

• educate purchasing
• allow for allocation on basis of use
• help identify necessary refreshes, updates and retirement
• streamline procurement
• allow you to proactively plan for upgrades
• identify and execute preventative maintenance tasks
• avoid unnecessary disrepair, waste and excess costs
• eliminate over-purchasing
• realize the optimal life span of each and every computer.

Build your reporting system around a resource-light SaaS system and you accomplish all these things with a minimal cash outlay.

Regulatory compliance: Systems with off-network tracking capabilities let you better collect, store and manage data needed for corporate and regulatory compliance. Automated inventory systems help ensure data is consistent, accurate, up-to-date and easily accessible at all times – key to fulfilling audit requests and proving compliance measures.

Proactive security: Is your job secure no matter what results you produce? Few are. The fastest route to a pink slip is allowing a preventable HIPAA breach. If you have detailed knowledge of where mobile devices are located, who is using them and what is installed on them, you can more easily identify and monitor potential security risks – such as suspicious machine movement, unfamiliar usernames, unauthorized downloads and other non-compliance activities. Proactive security measures can then be taken, minimizing loss, theft, the resulting data breach risk– and harsh regulatory penalties.

And in the end…

Managing mobile PCs, PDAs and smart phones is different from managing office computers. If you are the individual responsible for this aspect of a 21st-Century home health care agency or hospice, you have already realized that using traditional methods is difficult and less effective.

Mobile computers will leave your network, employees will tamper with them, and your line of sight into them will become muddied. By adopting systems which can accurately and automatically track them regardless of their physical location, resist tampering and do it all without a new server stack, you too can be an IT hero.

——————————

1Info-Tech Research Group, Where’s Your Laptop? Incorporating Laptops into IT Asset Management Practices, January 2010.

2 Ponemon Institute, The Cost of a Lost Laptop, April 2009.

3 Ponemon Institute, The Human Factor in Laptop Encryption.

According to The New England Journal of Medicine, avoidable hospital readmissions within 30 days of discharge cost Medicare $17.4 billion per year. CTA’s “Technologies for Improving Post-Acute Care Transitions” (Tech4Impact) grants are designed to encourage creation of new programs through the national system of Aging and Disability Resource Centers (ADRC).

CTA director David Lindeman said, “Use of selected technologies such as remote patient monitoring and medication management technologies is associated with reduced hospitalizations, so it makes sense to focus on expanding their use.”

Tech4Impact grants will complement grantee funding made available through the $60 million AoA and CMS initiative, “Implementing the Affordable Care Act: Making it Easier for Individuals to Navigate their Health and Long-Term Care through Person-Centered Systems of Information, Counseling and Access.”

Complete details are available at: www.aoa.gov/AoARoot/Grants/Funding/index.aspx.

Additional guidelines pertaining to Tech4Impact grants are available at www.techandaging.org

CTA will make Tech4Impact funds available to states that are awarded grants by AoA/CMS for program Option D: ADRCs Evidence-Based Care Transition Programs. (AoA/CMS grant applications are submitted electronically at www.grants.gov.) The CTA application for states will be released by September 30, 2010, and full proposals will be due October 15, 2010. Grants are expected to commence by January 2011.

ADRCs (www.adrc-tae.org) are community-based programs designed to streamline access to long-term care services under the auspice of the Administration on Aging, an arm of the U.S. Department of Health and Human Services.

In addition to this newly announced program, CTA administers grant-funding for projects that seek to expand the use of medication optimization and remote patient monitoring technologies for the care of older Americans. CTA was established with funding from The SCAN Foundation (www.thescanfoundation.org) and is affiliated with the Public Health Institute (www.phi.org) in Oakland, California.

From the CTA web site:

The important work of the Center for Technology and Aging would not be possible without the generous support of The SCAN Foundation, a creation of the Senior Care Action Network not-for-profit health plan. Through an initial grant of $5 million The SCAN Foundation has supported the establishment of the Center to promote the independence and well-being of older adults through the broader diffusion of beneficial technologies. The Center serves as a national resource for providers and policy makers who are engaged in using technology to enhance the lives of older adults.

The Center funds demonstration programs to test strategies to promote the diffusion of technology. We also serve as a trusted and independent expert voice on current technology, providing unbiased analysis and basic facts on technologies that help promote the independence of older adults. In addition, we are a source of information concerning current research, implementation tools, and policy initiatives related to technologies that help older adults maintain their independence.

www.techandaging.org

To participate: 800-837-1935

Conference ID: 89682139

Topic Overview:

The August 2010 Home Health, Hospice & Durable Medical Equipment Open Door Forum will address three unique health care concerns within the Medicare and Medicaid programs: issues related to Home Health PPS, the newly proposed competitive bidding for DME and the Medicare Hospice benefit.

Many issues to be covered bridge concerns within all three settings. Timely announcements and clarifications regarding important rulemaking, agency program initiatives and other related areas are also scheduled to be included.

The proposed rule, on display in the Federal Register today, represents a 4.75 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011. This is an estimated net decrease of $900 million compared to payments HHAs received in CY2010. It includes the combined effects of a market basket update, a wage index update, reductions to the home health prospective payment system (HH PPS) rates to account for increases in aggregate case-mix that are unrelated to underlying changes in patients’ health status, and other provisions mandated by the Affordable Care Act (ACA) of 2010.

The ACA mandates that CMS apply a 1 percentage point reduction to the CY2011 home health market basket amount, which equates to a proposed 1.4 percent update for HHAs in CY2011. CMS also proposes to further reduce HH PPS rates in CY2011 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status. Based on updated data analysis, instead of the planned 2.71 percent reduction for CY2011, CMS proposes to reduce HH PPS rates by 3.79 percent in CY2011 and an additional 3.79 percent in CY2012.

The ACA also changes the existing home health outlier policy through a 5 percent reduction to HH PPS rates, with total outlier payments not to exceed 2.5 percent of the total payments estimated for a given year. HHAs are also permanently subject to a 10 percent agency-level cap on outlier payments.

“The new HH PPS provisions will help ensure more accurate payments under Medicare and reflect prudent financial stewardship of the Medicare Trust Fund,” said Jonathan Blum, director of the Center for Medicare and deputy administrator for CMS.

The proposed rule also offers an approach to implement an ACA provision, which mandates that, prior to certifying a patient’s eligibility for the Medicare home health benefit, the physician must document that the physician or a non-physician practitioner has had a face-to-face encounter with the patient. “Patient care and access are ultimately what CMS is looking to protect, while working aggressively to prevent fraud. The proposed rule establishes timeframes for these encounters and documentation requirements associated with the provision,” Blum said.

In CY2010, CMS finalized a policy, which requires HHAs that change ownership within three years of initial enrollment to obtain a new State survey or accreditation. CMS now proposes exceptions to the 36-month provision for certain types of ownership transactions. CMS also proposes other changes to the 36-month rule and provides further clarification on its capitalization provisions. In addition, CMS proposes to clarify policies regarding the coverage of therapy services in the home health setting. Further, CMS provides clarification in this proposed rule regarding the quality reporting requirements for the CY2012 HH PPS rate update, as it relates to the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey.

Finally, the rule proposes an approach to implement an ACA hospice provision, which requires a hospice physician or nurse practitioner to see a patient prior to recertifying the patient’s eligibility for hospice services.

Background

To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician, have an intermittent need for skilled nursing care, or need physical or speech therapy, or continue to need occupational therapy. The beneficiary must be homebound and receive home health services from a Medicare approved home health agency.

Medicare pays HHAs through a system of prospective payments that pays at higher rates to care for those beneficiaries with greater needs.  Payment rates are based on relevant data from patient assessments conducted by clinicians as currently required for all Medicare-participating HHAs.

Home health payment rates are updated annually by the home health market basket percentage increase. CMS uses the home health market basket index, which measures (and tracks) inflation in the prices of an appropriate mix of goods and services included in home health services.

Section 5201(c) of the Deficit Reduction Act (DRA) of 2005 provides for an adjustment to the home health market basket percentage update for CY2007 and subsequent years depending on HHAs submission of quality data.  HHAs that submit the required quality data would receive payments based on the home health market basket update of 1.4 percent for CY2011. If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.6 percent for CY2011.

More information is available at www.healthcare.gov, a new web portal made available by the U.S. Department of Health and Human Services.

The proposed rule will be published on July 23, 2010 at the Federal Register. The rule can be located at: http://edocket.access.gpo.gov/2010/pdf/2010-17753.pdf

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. EDT on September 14, 2010.

ADDRESSES: In commenting, please refer to file code CMS–1510–P. Because of
staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of four ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the instructions under the ‘‘More Search Options’’ tab.
2. By regular mail. You may mail written comments to the following address ONLY:Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1510–P, P.O. Box 1850, Baltimore, MD 21244–1850.Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1510–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.
4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period to either of the following addresses:

a. For delivery in Washington, DC:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244–1850.

If you intend to deliver your comments to the Baltimore address, please call (410) 786–7195 in advance to schedule your arrival with one of our staff members.

Comments mailed to the addresses Indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

Submission of comments on paperwork requirements

You may submit comments on this document’s paperwork requirements by following
the instructions at the end of the ‘‘Collection of Information Requirements’’ section in this document.

For further information, contact:

• Randy Throndset, (410) 786–0131 (overall HH PPS).
• James Bossenmeyer, (410) 786–9317 (for information related to payment safeguards).
• Doug Brown, (410) 786–0028 (for quality issues).
• Kathleen Walch, (410) 786–7970 (for skilled services requirements and
  clinical issues).

Inspection of Public Comments:

All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.

Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. ET. To schedule an appointment to view public comments, phone 800–743–3951.

Chicago, IL and Lynchburg, VA — July 20, 2010

Allscripts (NASDAQ: MDRX) announced last week that Centra, a three-hospital system in Central Virginia, has selected the Allscripts Electronic Health Record (EHR) for its staff physicians and the Allscripts Community Exchange as the platform for electronically connecting the medical community in its region, including Centra’s home health agency.

Centra will initially provide Allscripts’ EHR to over 70 physicians and midlevel practitioners, both employed and affiliated private-practitioners, then extend it to over 250 providers in its service area.

“Our goal is to achieve true community physician integration,” said Ben Clark, Centra’s Chief Information Officer, “to connect the community and extend our electronic health record across our whole sphere of service.”

Allscripts Community Exchange can exchange key clinical data among disparate EHRs, a benefit in a community with at least nine different deployed EHRs.
In addition, Clark pointed out, it will allow Centra to use an Enterprise Master Patient Index, or EMPI, helping ensure that every piece of medical information is associated with the correct patient across the continuum of care.

Allscripts’ Homecare application will enable clinicians to access more information and share that data with other caregivers via an enterprise physician portal.

“Centra has a history of treating the patient for the whole continuum of care, from birth to end of life,” Clark said. “Allscripts Homecare is the perfect fit. We have Allscripts in our emergency department already, and now we are about to deploy their EHR in the ambulatory environment. When we add the Homecare product, we will be using the same platform across a large part of the care continuum. As we continue to expand our connectivity, the Allscripts suite of products will continue to improve the quality of care and show our community the value of a truly integrated health system.”

A custom interface will link Allscripts Homecare to Centra’s enterprise information system, noted Clark. By posting the home health data on the physician portal, he explained, Centra hopes to keep physicians better informed about their patients’ progress, which should lead to reduced readmissions.

“Similarly, the use of Allscripts Community Exchange will ensure proper medication reconciliation during care transitions and will prevent duplication of orders as patients move from one care setting to another,” he continued. “Should a patient present in the ED, the ED physicians will have instant access to all of his or her records, speeding medical decision-making.”

“A connected community enables clinicians to get the maximum value out of health information technology,” said Allscripts CEO Glen Tullman. “By having the right information on the right patient at the right time, physicians and other providers can make better decisions and deliver the appropriate care when it will make the most difference in outcomes. We commend Centra for taking this visionary approach to the deployment of Electronic Health Records and connectivity across the community.”

A Lynchburg-based not-for-profit health system, Centra operates two main hospitals, Lynchburg General and Virginia Baptist. In January 2006, Southside Community Hospital in Farmville joined Centra as an affiliate.

www.allscripts.com

The American Telemedicine Association invites telemedicine and home telehealth practitioners to submit an abstract to be considered for inclusion in the association’s 16th Annual International Meeting and Exposition educational program. Peer-reviewed presentations typically discuss real-world successes achieved through the use of remote patient monitoring.

Proposals will be accepted through September 15, 2010.

The ATA sannual meeting is the largest international meeting and exposition focusing exclusively on telemedicine, telehealth & remote medical technologies. It is the primary opportunity for home telehealth users and those considering remote patient monitoring technologies to listen to and interact with international experts and virtually all of the segment’s vendors.

ATA CEO Jonathan Linkous describes the meeting’s peer-reviewed educational program as one that “sets the standard for continuing medical education on the topics of telemedicine and telehealth.” The 2011 meeting is set for Tampa, Florida, May 1-3. Visit the ATA web site at www.atmeda.org or click here to go directly to the page to submit an abstract.

Home care software developer HealthWyse is providing software and services for its clients to make it easier to comply with the new PECOS regulation.  HealthWyse will offer a service that will automatically update the client’s physician database with the latest PECOS file from CMS. During the patient intake process, the software will indicate whether the referring physician is enrolled in PECOS.  There will also be a Management List that will flag those physicians with active patients who are not yet enrolled.

HealthWyse spokesperson Steven Booth said the vendor’s objective is to help clients automate these administrative processes so that they can focus on providing patient care. “This is an example of the advantages of deploying a hosted architecture,” Booth said. “Because we host the master copy of our client’s database, this is a relatively easy solution for us to put into place.”

HealthWyse customers also routinely replicate their data locally in order to maintain their own mirrored-copy. Some use a web-browser to access their data directly from the HealthWyse data center. “In either case,” Booth added, “HealthWyse automates updating PECOS data.”

Since October, 2009 Medicare EOB’s have included warnings about non-compliant physicians. Eventually, home care intake personnel will find themselves in the awkward position of having to refuse a patient and inform the referring physician the refusal is due to his or her failure to register in the PECOS database, preventing the home care agency from being paid if they were to provide services.

What is not clear yet is whether Medicare contractors will attempt to recoup monies paid during the warning period in a future audit. Since a payment denial reason such as this one is easily detected through automated computer audits, there is reason to believe it will attract the attention of Recovery Audit Contractors (RAC) if they ever turn their attention to home care.

Home infusion providers have an option if their software vendor does not offer a PECOS search function such as the one HealthWyse has announced. Rock-Pond Solutions, of Conway, Arkansas, released a PECOS Database Audit tool that will extract physician lists from CPR+, HomecareNet, Ascend-HI and Ascend or receive an Excel file from any system and audit it against the CMS PECOS database.

Rock-Pond CEO Pete Tanguay explained that his $600 service will provide audit results within 24 hours, notify the user when CMS updates its published data file, accept user physician files for PECOS audit an unlimited number of times for a year. Rock-Pond will accept physician files and process them at no charge through the end of July.

Federal agents charged 94 people in Miami, Florida; Baton Rouge, Louisiana; Detroit, Michigan, and the Brooklyn borough of New York Friday with defrauding Medicare, the Department of Justice and other federal agencies said in a joint statement.

It is the largest health care fraud takedown since the creation of the Medicare Fraud Strike Force, known as H.E.A.T., three years ago. The defendants include doctors, health care company owners and executives, the statement said.

“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Health and Human Services Secretary Kathleen Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”

The defendants are charged with conspiring to submit over $280 million in false claims to the federal health care program designed to aid the elderly.
Thirty-six defendants charged in the schemes have been arrested and additional arrests were expected throughout the weekend, federal officials said.

Charges include filing fraudulent claims for HIV/infusion services, home health care, physical therapy and durable medical equipment.

The Medicare Fraud Strike Force is a joint effort by the Department of Justice and the Department of Health and Human Services. The team works with federal, state and local investigators to analyze Medicare data and emphasizes community policing.

“With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet,” Attorney General Eric Holder said. “The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”

Health care fraud fighters in Florida will now have additional funding to help find potential fraud and abuse in the state’s Medicaid program through use of Medicaid claims data.

Secretary Kathleen Sebelius announced this week that the U.S. Department of Health and Human Services (HHS) has approved Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit (MFCU) to “mine” Medicaid Management Information System (MMIS) data to identify cases of potential Medicaid fraud.

Medicaid billing for many health care services in South Florida is disproportionately high compared to other parts of the country. Although significant progress has been made, fraudulent health care billing continues to cost Medicaid millions of dollars.

“To fight health care fraud, we need to coordinate all of the resources and data we can muster,” said Secretary Sebelius. “By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida’s ability to effectively identify and combat fraud and abuse.”

The announcement comes in advance of the first joint HHS and Department of Justice (DOJ) Regional Health Care Fraud Prevention Summit, held at the Knight Center in Miami.

The summit, which featured keynote remarks by U.S. Attorney General Eric Holder and Secretary Sebelius, kicked off the first in a series of day-long summits bringing together a wide array of federal, state, and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.

As part of its efforts to coordinate the fight against fraud across the nation’s health care systems, including Medicaid and Medicare, data mining will allow Florida’s MFCU to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and potentially fraudulent billing. Data mining is done with software programs which include algorithms that automatically analyze MMIS data.

Currently, state MFCUs are prohibited from using federal Medicaid matching funds to detect potential fraud through routine claims review procedures such as screening of claims, analysis of billing practice patterns, or routinely verifying that billed services were actually received by patients, since these functions are a primary program operation function of the state Medicaid agency. Instead, MFCUs generally rely on referrals from the State Medicaid agency. The newly approved waiver will allow the Florida MFCU to use federal matching funds to apply sophisticated electronic data mining tools that are beyond the scope of the claims review activities normally performed by the State Medicaid agency to identify potential fraud.

CMS expects the MFCU to work closely with AHCA to ensure their collective efforts are effective. CMS will monitor progress of this waiver in conjunction with the HHS Office of Inspector General, which has oversight of MFCUs.

“The demonstration approved today will allow Florida’s Medicaid Fraud Control Unit to take full advantage of its expertise in detecting and investigating Medicaid fraud,” said CMS Administrator Don Berwick, M.D.

In other federal news, HHS has announced awards of $10 million to 10 national non-profit organizations to support public health efforts to reduce tobacco use and reduce obesity through increased physical activity and improved nutrition.

These competitive awards are part of the HHS Communities Putting Prevention to Work (CPPW) initiative, a comprehensive prevention and wellness initiative funded under the American Recovery and Reinvestment Act of 2009.

“Communities Putting Prevention to Work” will help communities implement prevention policies including incentives to food retailers to locate and offer healthier options in underserved areas; healthier choices in child care, schools, and the workplace; subsidized memberships to recreational facilities; safe routes to school; and evidence-based strategies that discourage tobacco use and increase utilization of cessation programs.

“In the United States, seven of 10 deaths result from chronic disease, with tobacco, obesity, poor nutrition and lack of physical activity as the key risk factors for disease,” said HHS Assistant Secretary for Health Howard K. Koh, M.D., M.P.H.

The awardees are:

• American Academy of Pediatrics
• American Heart Association
• American Lung Association
• Association of American Indian Physicians
• BlazeSports America
• Community Food Security Coalition
• National Association of Latino Elected Officials
• National Recreation and Parks Association
• Sesame Workshop
• Society for Public Health Education

In addition to these new grant awards to national organizations, HHS will soon launch a National Prevention Media Campaign that will deliver hard-hitting advertisements to complement and support the work of CPPW. A contract for $28 million was recently awarded to the Academy for Educational Development (AED).  This new media contract will also develop consumer materials for First Lady Michelle Obama’s Let’s Move! campaign aimed at preventing childhood obesity.

Links:

http://www.hhs.gov/ophs/funding/cppwfactsheet.htmlhttp://www.hhs.gov/recovery/programs/cppw/factsheet.htmlhttp://www.cdc.gov/chronicdisease/recovery

“This project will help the industry take necessary steps to promote the provision of optimal rehabilitation services to the elderly and disabled” says NAHC president Val Halamandaris. “As an industry, we need to insure best practices in therapy, from assessment through service delivery and documentation. We feel the best way to do this is to join with others to establish a National Forum to bring together home care therapy experts from every state. The project goal will be to generate best practice recommendations for ensuring appropriate delivery of therapy services.”

To be known as the “Delta National Excellence in Therapy Project,” the study will be sponsored by Delta, and co-sponsored by NAHC, by the Home Health Section of the American Physical Therapy Association, by the Home & Community Health Special Interest Section of the American Occupational Therapy Association and by Fazzi Associates. Fazzi Associates will be responsible for designing and facilitating the national effort.

This is the second major national effort within the past year that Delta has sponsored and Fazzi has carried out. “We sponsored the “National OASIS-C Best Practices Project” because we knew agencies throughout the country were concerned about how to ensure competency and accuracy when using the new OASIS instrument,” said, Keith Crownover, president and CEO of Delta. “Today, we recognize that the appropriate use of therapy is of concern to the entire industry – clinicians, agencies and information system vendors alike. As a thirty-six year member of the home care industry, we at Delta felt it was important that we help sponsor an effort that will benefit the entire industry.”

Cindy Krafft, president of the Home Care Section of the American Physical Therapy Association and Director of Fazzi’s Rehab Services, echoes Crownover’s view. “From therapy associations’ perspective, it is critically important that the role and integrity of therapy services within home care be clearly understood and appropriately used,” Krafft said, capturing the motivation for both therapy associations to agree to co-sponsor the effort.

The Project is now in the process of recruiting a therapy leader from each state to participate in the effort, which will be overseen by a project steering committee. A national input survey will be the project’s first activity, inviting leaders and staff from agencies throughout the country to have input and help shape the project. The National Forum is expected to meet in Chicago in September with initial findings presented at the NAHC Annual Meeting in Dallas in October.

As part of the effort, a series of free national webinars on the results and recommendations will be scheduled for late October or early November. A major report on the findings and recommendations will be issued at project end.

Links:

Home Health Section of the American Physical Therapy Association

Home & Community Health Special Interest Section of the American Occupational Therapy Association

Fazzi Associates

Delta Health Technologies

The “Indiana Cancer Pain and Depression Trial” (INCPAD) included patients in 16 community-based urban and rural cancer practices. Of the 405 participants, 202 patients were assigned to the intervention program and 203 received usual care; 131 had depression only, 96 had pain only, and 178 reported having both depression and pain.

Half of the participating patients received automated home-based symptom monitoring by interactive voice recording or Internet. They were also monitored by a centralized home telecare system managed by a nurse-physician specialist team. The patients were assessed for signs of depression and pain symptoms at the start of the study, and then again at one, three, six and 12 months.

After 12 months, the 137 patients with pain in the intervention group showed greater improvement in pain symptoms than the 137 patients with pain and receiving standard care. The 154 patients with depression in the intervention group had significantly greater improvement in depression severity than the 155 patients with depression in the usual-care group. The report appeared in the July 14 issue of the Journal of the American Medical Association.

Dr. Kurt Kroenke, of the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute in Indianapolis, said the trial demonstrated that it is feasible to provide telephone-based centralized symptom management across multiple, geographically-dispersed, community-based practices in both urban and rural areas by coupling human interactions with technology-assisted patient interactions.

He added that the study’s findings did not appear to be confounded by differential rates of co-interventions or health care use.

“The fact that INCPAD was beneficial for the most common physical and psychological symptoms in cancer patients demonstrates that a collaborative care intervention can cover several conditions, both physical and psychological,” the researchers concluded.