ÐÇ¿ÕÈë¿Ú

HHAs' profit margins, HHRG coding accuracy, and OASIS data will be some of the critical issues the federal watchdog addresses in 2011.

The data you've been putting into your cost reports could make or break home health agency payment rates, thanks to one of six new reports the HHS Office of Inspector General plans about home health agencies next year.

"We will review cost report data to analyze HHA profitability trends under the home health PPS to determine whether the payment methodology should be adjusted," the OIG says in its newly released 2011 Work Plan. "Since the PPS was implemented in October 2000, HHA expenditures have significantly increased."

The watchdog agency plans to focus special attention on profit margins by provider type. "We will examine ... the overall profitability trends for freestanding and hospital-based HHAs," the OIG says.

The OIG plans five more HHA reports for 2011 on these topics:

• HHRG accuracy. Agencies submit the data that sets the HHRG and corresponding payment level, the OIG notes. The report will examine HHRG accuracy for episodes in 2008 and will "identify characteristics of miscoded HHRGs." The OIG also will examine whether sampled claims meet Medicare billing criteria in general, including homebound status and plan of care requirements.

• OASIS data. The Centers for Medicare & Medicaid Services uses OASIS data for payment and for gauging agencies' quality of care, the OIG notes in the plan. "We will review CMS's process for ensuring that HHAs submit accurate and complete OASIS data.

• Payment controls. The OIG will examine billing trends including utilization figures. Billing for appropriate location of service will also be under the microscope. "Total payments to HHAs have increased substantially from $8.5 billion in 2000 to $16.4 billion in 2008," the Work Plan points out.

• Enrollment. "We will determine whether ... program integrity efforts of CMS, its contractors, and states identify and prevent the enrollment of questionable HHA applicants," the OIG says.

• Medical supplies. The OIG wants to make sure Medicare isn't paying double for medical supplies. Certain Part B items and services are bundled into the home health prospective payment system rate, it notes.

Plus: The OIG plans two reports on hospices, both focusing on hospice-skilled nursing facility relationships. And the agency plans a whopping 12 reports on durable medical equipment supplier issues ranging from competitive bidding to supplier influence on physician prescribing.