American Academy of Home Care Physicians
Promoting the art, science and practice of medicine in the home.

1999 Vol. 11 No. 3
Issn# 1049-0027

Government Update
By: C. Gresham Bayne, MD

OASIS
To the AAHCP goes some of the credit for the Congressional and HCFA decision to implement OASIS, with some of the changes the Academy supported. Under the final regulation, agencies must conduct comprehensive assessment and updates using OASIS, but will hold them as part of the patient's clinical record rather than transmitting them for non-Medicare/non-Medicaid patients, transmitting data only for Medicare and Medicaid patients receiving skilled care at this time. HCFA plans to expand transmission to the non-Medicaid/Medicare patients next spring. Other changes were made to increase patient privacy, including elimination of the transmission of sensitive patient financial status data. Still unresolved and important, is payment of agencies for data collection and transmission.

Proposed Physician Payment Rule Published July 22, 1999 in the Federal Register Numerous proposed changes in Part B physician payment methodology were published July 22, 1999 in the Federal Register 42 CFR 415 beginning on page 39608. Those that may affect home care physicians are briefly summarized below:

1. Pulse oximetry is proposed to be bundled into all evaluation and management codes.

2. All requirements for supervision of nurse practitioners and clinical nurse specialists would be removed; i.e. the requirement for "general supervision" would be removed and federal coverage would default to State policies.

3. Specifically with respect to XRays or lab tests, NPs and CNSs would have no other requirements than those under the CLIA laboratory regulations.

4. Physician Assistants would still require general supervision in order to be reimbursed under Part B.

5. The times for physical therapy codes were generally lengthened.

6. A code modifier (-25) would be used for evaluation and management services, such as home visits, when services were clearly necessary in addition to a procedural code such as debridement or suturing a laceration.

7. The malpractice expenses have been adjusted, which will increase home visit reimbursement by roughly 1%.

8. EKG comprehensive reimbursement will increase by 3%, although no proposal to reinstitute the transportation of EKG codes for payment was announced.

The cumulative effect of these and many other broader changes proposed would increase home visit fees variably across the family of codes from 1-3% based on 1999 dollars. Global adjustments, such as the correction factor, will be applied on top of such proposed changes.