Archive for 'Hot Topics'
Know these Hospice Claim Requirements to Keep Reimbursement Flowing
Posted on 09. Jun, 2010 by jan.mater.
Report social work phone calls separately, even when they each last less than 15 minutes
This year has already been a busy one for new claim requirements, and the change requests aren’t over yet. From itemizing visits to tracking social work phone calls and line item billing for levels of care, if you aren’t reporting the details correctly, you could be risking denials.
1. Itemize visits per day in billing. 2010 began with change request 6440 which was effective for service dates on or after Jan. 1.
This new claim requirement changed the way hospice visits are reported,requiring line item billing of visits for all service disciplines (nursing, medical social services, and aides) in 15-minute increments, rather than on a weekly basis, says M. Aaron Little, CPA, senior managing consultant with BKD in Springfield, MO.
Each visit on a particular day must now be listed individually, Little says. Plus, you must now bill for therapy services performed by direct staff and contract staff addressing the terminal illness.
The change applies to visits provided by hospice employees to patients receiving routine home care,continuous home care, or respite care.
Coming up: Watch for visit reporting for chaplains and volunteers likely to be required in the future, Little predicts.
2. Track social work phone calls. C.R. 6440 also requires that you report medical social services phone calls for providing care to or coordinating care of a patient for the palliation and management of the terminal illness and related conditions, Little says. Calls that involve counseling the patient’s family should also be reported.
These calls must all be described in the plan of care and documented in the clinical record, Little says. Each reportable call should be reported on the claim as a billable visit.
Confusing: This requirement could result in situations where three calls occur in a 20 minute span and you must bill for each call separately, even though they each lasted less than 15 minutes, Little points out.
3. Report two physicians. For claims and notices of election with dates of service on or after April 1, CR request 6540 requires that you report two physicians. This new requirement means you must report both the attending physician and the hospice physician certifying the terminal illness, Little says.
And this requirement holds true even if the attending physician and hospice physician is the same individual. In that case, you would list the same physician’s name in both required claim fields.
4. Use line items for levels of care. You should be providing line item reporting of hospice levels of care for claims received on or after April 29, 2010, according to requirements in change request 6791.
Now, for routine home care (RHC), respite care (RC), and general inpatient care (GIP), new claim service dates and lines must be reported each time a level of care changes, Little says. Service units must report consecutive number of days at that level of care and the service date must report the first date at that level of care.
Note: The effective date for this requirement isn’t based on date of service, but on when the claim was received by Medicare, Little says.
Continue Reading
Alcohol: Enabler of HIV Disease
Posted on 09. Jun, 2010 by Editor.
A Miami study says HIV-positive heavy drinkers are nearly three times at risk.
Moderate and heavy drinking might accelerate HIV disease development on patients who consume two or more alcoholic drinks every day, says a study in Miami.
The research — published online in the journal AIDS Research and Human Retroviruses — found that of the 231 HIV-positive individuals who were monitored during a 30-month period, 54 percent consumed alcohol. Among this group, 23 (more…)
Continue Reading
RACs Won’t Keep Fees After Losing Appeals
Posted on 02. Jun, 2010 by jan.mater.
Plus: You’ll soon be able to review the most common errors that the RACs find.
The feds are attempting to limit the amount of bounty that the so-called RAC “bounty hunters” are able to collect, to the delight of many providers.
Continue Reading
Caregivers and Brain Cancer Patients Don’t See Eye-to-Eye
Posted on 02. Jun, 2010 by Editor.
Do you know what important role caregivers play on rating quality of life?
Compared to other types of cancer, malignant gliomas or primary brain tumor has huge effects on a patient’s personality, language function, and overall functionality. Yet people afflicted with brain cancer assess their well-being more optimistically than their caregivers do, a recent study by the Northwestern University Feinberg School of Medicine has found.
One reason may be because a caregiver knows more about the patient’s clinical state than the patient himself. Another (more…)
Continue Reading
Restrictions to Opioid Drugs, A Legal and Moral Issue
Posted on 26. May, 2010 by Editor.
Eastern European countries have the most limitations, impeding proper patient care.
A study in Europe cries foul over government regulations restricting access to opioid-based drugs such as morphine. Curbing the availability and access of the painkillers violates a patient’s human rights, reported the authors of the study.
Continue Reading
Palliative Sedation in the Eyes of NHPCO
Posted on 19. May, 2010 by Editor.
The organization draws the line between palliative sedation and many issues, including euthanasia.
Families and health care providers should consider palliative sedation as an option for imminently dying patients with intolerable pain, and unresponsiveness to other interventions, the National Hospice and Palliative Care Organization (NHPCO) maintains.
Continue Reading
County Public Health Office Scores Big on Palliative Care
Posted on 19. May, 2010 by Editor.
Lung patient was hospital-free for 5 straight weeks.
New York state’s Washington County has launched a new palliative care program that will keep chronically ill patients out of hospitals and in the comforts of their own homes.
Since it’s October start, 21 residents have been accepted into the program. Ann (more…)
Continue Reading
Medicaid RACs Slated To Fire Up This Year
Posted on 12. May, 2010 by jan.mater.
Will the new Medicaid bounty hunters duplicate MIC scrutiny?
If you submit claims to Medicaid, get ready for another set of eyes looking over your shoulder.
The Patient Protection and Affordable Care Act (PPACA) calls for every state Medicaid program to contract with at least one Recovery Audit Contractor to review claims. That totals a minimum of 56 Medicaid RACs, points out consultant Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas. (more…)
Continue Reading
Palliative Medicine Goes Beyond Physical
Posted on 12. May, 2010 by Editor.
Clinicians should get involved in taking care of a patient’s spiritual needs.
Each member of a palliative care team should take up roles outside of their niche by looking after a patient’s physical, as well as psychological, social and spiritual needs, a speaker at a recent American Academy of Hospice and Palliative Medicine (AAHPM) Assembly said.
Tim Ford, MA MS CT at VCU Massey Cancer Center, Richmond, VA, introduced the importance of “transdisciplinary” (TD) approach to palliative care, as opposed to the more traditional “interdisciplinary” (ID) approach. In TD, a clinician providing palliative care to a patient functions as a generalist while (more…)
Continue Reading
OASIS C Education: Clearly Indicate Your Patients’ Pain
Posted on 05. May, 2010 by jan.mater.
Follow this expert advice to ensure you correctly assess pain.
Just because an item in OASIS C asks about pain doesn’t mean your response should note how much pain your patient experiences. Sometimes, the point is simply whether you’ve asked the right questions.
For completing OASIS C, you should consider pain as “the fifth vital sign,” notes Rebecca Friedman Zuber, a Chicago-based regulatory consultant. A patient’s pain levels throughout treatment are as important as their blood pressure or temperature. (more…)
