Archive for 'Did You Know?'

Face-to-Face Encounter Requirement – Some Respite on the Narrative in F2F Medical Review?

Posted on 07. Jul, 2014 by .


NAHC is further holding on filing the lawsuit to give CMS the chance to assess the concerns and the changes sought by the trade association.

In March, the National Association for Home Care & Hospice (NAHC) informed that it had decided to file a lawsuit over onerous face-to-face physician encounter requirements. But the trade group postponed the filing of the suit so it could meet with the CMS on the issue. A couple of months back, on May 8, 2014, the group’s representatives met with CMS. The main goal of the trade group is to secure elimination of the physician narrative portion of the F2F requirement.

HHAs have long challenged that while the F2F encounter requirement is contained in the ACA law, the narrative portion of the requirement is not.

Lawsuit will wait

Based on the discussions at the meeting with CMS, the trade association is further holding on filing the lawsuit to give CMS the chance to assess the concerns and the changes sought by NAHC.

The trade group has also expressed that if they see that they are not making enough and fast progress with CMS, the lawsuit is fully prepared for immediate filing in federal court.

The means for CMS to bring F2F regulatory change would be the 2015 home health prospective payment system rule. The agency will propose in late June or early July.

The trade association and other industry reps have criticized the F2F audits recently launched by Supplemental Medical Review/Specialty Contractor Strategic-HealthSolutions. An OIG report showed that those SMRC audits will hit every single home health agency across the country. However, they are eyeing an all-embracing suspension of enforcement of the physician narratives by all of the Medicare contractors, meaning Medicare would continue to assess all other elements of Medicare coverage and the F2F requirements.

However that does not mean you can stop collecting physician narratives. Firstly, the Centers for Medicare and Medicaid doesn’t even consent to suspend the narrative part of F2F review. CMS has proven intractable previously as far as the F2F issue is concerned.

Between now and the issuance of a final rule, several discussions and meetings have been prepared. At each meeting, NAHC will assess progress to determine if litigation is necessary. For more on F2F requirements and the latest home care news, stay tuned to

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Attention Home Care Providers! Don’t Get Caught in the Cost Report Confusion

Posted on 24. Jun, 2014 by .


Even though some provider types now have the Form CMS 339 Questionnaire included in their cost reporting form, HHAs and hospice providers are still required to file a separate Form CMS 339.

These days home care providers have a new issue to deal with – cost report confusion. So if you do not meet cost and report related requirements, don’t be surprised if your payments take a hit.

Background: Recently, Palmetto GBA informed the provider community that quarterly Credit Balance Reports were due April 30, 2014. Suspension Warning letters were mailed that read suspension of all claims reimbursements at 100% would commence in 15 days from the date of issuance of the letter if the credit balance report is not received on time. The suspension started with June 3 Remittance Advices and will continue until the credit balance report is received. (more…)

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OASIS C: Focus on Patient’s Ability When Responding to 1810/1820

Posted on 02. Jun, 2010 by .


Hint: Modified clothing choices could level the playing field.

After struggling for months to dress herself, your patient decides to modify her clothing choices so that she is no longer dependent on an aide for help.

Do you know how her choice will affect your OASIS C selections? Follow this guidance to ensure you make the correct assessment:

Amount of Assistance is Key

Your responses to items 1810 (Current ability to dress upper body safely…) and 1820 (…lower body…) hinge on two (more…)

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AIDS Survivors Face Greater Risk of Cancer

Posted on 02. Jun, 2010 by .


A clinical trial suggests antiretroviral drugs can cause serious side effects.

The longer an AIDS patient survives his condition, the more they are likely to develop cancers. New research has found high rates of cancers not previously associated with AIDS in the subjects studied. (more…)

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Know Your Patient’s Rights: Does Your Hospice NOE Pass Muster?

Posted on 26. May, 2010 by .


Don’t let these four common errors trip up your claims.

Are you sure your notice of election statement covers all the bases? The Office of Inspector General’s (OIG) Fall 2009 report found that that 33 percent of the hospice claims it examined didn’t meet notice of election requirements. Make sure you’re not missing one of the five vital pieces of information that your NOE must cover. (more…)

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Get the Skinny on ICD-9 Symptom Coding

Posted on 12. May, 2010 by .


Read sequencing instructions to catch exceptions to the symptom coding rule.

You’ve heard it said before: Don’t code the symptom when you have a definitive diagnosis. But even when you keep this general guideline in mind, symptoms can still trip you up. Get the final word on when to report symptom codes.

What is a Symptom?

A symptom code is one that describes some sign or symptom that the patient is experiencing without having a diagnosis that confirms the symptom, says Tricia A. Twombly, BSN, RN, HCS-D, CHCE senior education consultant and director of coding with Foundation Management Services in Denton, Texas:

So, if you have a patient who is exhibiting symptoms and they don’t have a more definitive diagnosis it’s appropriate to code for the symptom.

Example: Your patient is experiencing shortness of breath and edema and has no diagnosis that explains those symptoms. In this case, you should code shortness of breath (786.05) and edema (782.3), Twombly says.

However, if the same patient has shortness of breath and edema and also has a diagnosis of congestive heart failure (CHF), then you would only list 428.0 (Congestive heart failure, unspecifed) because shortness of breath and edema are integral to CHF.

What Makes a Symptom Integral?

You shouldn’t code a symptom that’s integral to a disease process, but how do you know when the symptom makes the grade? An integral symptom is one that is associated routinely with a disease process, Twombly says. For example, shortness of breath and edema are routinely part of the disease process of CHF, so they are considered integral to the condition.

Another example: Your patient has liver failure and is experiencing ascites, urticaria, and jaundice. You would only code the liver failure because those symptoms are integral or routinely occur with liver failure (572.8), Twombly says.

But not all symptoms are integral. If your patient has Parkinson’s (332.0) and they are experiencing slurred speech (784.59) you would code both because not all Parkinson’s patients experience slurred speech.

Watch for Exceptions

Sometimes, even though symptoms are integral to the condition you’re instructed to code the symptoms in addition to the condition, Twombly says. For example, your patient has benign hypertrophy of the prostate (BPH) with urinary obstruction (600.01) when you turn to the tabular listing there is a sequencing instruction to “use an additional code to identify symptoms” even though all the listed symptoms are integral to BPH with lower urinary tract symptoms (LUTS).

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Family Caregivers Get Lonely and Depressed

Posted on 05. May, 2010 by .


Interventions to avoid breakdowns remain ineffective, study shows.

Family caregivers of patients with dementia usually get depressed due to stress. And they are often left alone to deal with their depression, according to a study conducted by Penn State and the Benjamin Rose Institute.

The study centered on the 15 most common stressors for caregivers, including financial strain, patient behaviors, frequency of help from family and friends, and caregiving time demands. Steven Zarit, professor and chairman of the department of human development and family studies at Penn State, and his colleagues found that the 67 people in the study experienced radically different types and amounts of stress. (more…)

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Death, TV-Style: Correcting Misperceptions in Palliative Care

Posted on 05. May, 2010 by .


Support group plays a big role in calming a dying patient.

Death is usually neither sudden nor painful — contrary to what many people think, says a palliative care specialist in Canada.

Romayne Gallagher, head of palliative care for Providence Health Care, describes people’s perception of death as one that is based on TV. She also said that family members of a terminally ill patient — often the caregivers themselves — have to deal with a lot of concerns, such as breathing patterns.

“I explain what we normally expect when someone is in palliative care,” Gallagher says in a report published by the Vancouver Courier. (more…)

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New Technology Connects Family, Elderly Patients

Posted on 28. Apr, 2010 by .


1 in 4 chronically-ill older Americans lives alone.

It’s a lonely world out there for sick, aged Americans. About four out of 10 chronically ill older people live alone and rely on others for caregiving. Such findings from a new study say family members should learn how to take care of their ill parents and relatives.

Dr Ann-Marie Rosland, study co-author and clinical lecturer at the University of Michigan (UM) Medical School, thinks that family members could help aging patients with chronic illness manage their conditions. (more…)

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Reduce Hospital Readmissions with Home Health EHRs

Posted on 22. Feb, 2010 by .


Here’s an easy way for physicians to peer into the post-acute ‘black box.’

Looking for funds to implement electronic medical records at your home health agency? Try hitting up hospitals that want to prevent hospital readmissions just as much as you do.

Integrated EHR just might reduce readmissions, according to the Breaking Down The Walls of Home Health IT” article published in the latest issue of CMIO. The “CMIO” acronym means “chief medical information officer” of a health system.

Several health systems are experimenting with ways to protect dwindling reimbursement that they think will result when Medicare looks to decrease its current $12 billion hospital readmission bill by bundling readmission costs into the initial visit. Some smart hospitals are seeing that data integration between them and HHAs can reduce potentially preventable readmissions for Medicare patients, including those for congestive heart faiture (CHF), diabetes, and COPD (more…)

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