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Hospice Claims To Require Yet More Info, Says CMS Transmittal 1897

Posted on 09. Feb, 2010 by .

April showers bring ... more paperwork.

April showers bring … more paperwork.

If the industry fails to get more specific, Medicare will start requiring line-item billing.

This spring, hospices will have yet another piece of data to include on their Medicare claims. As of Jan. 1, hospices have had to report visits or phone calls for nearly all hospice days billed, the Centers  for Medicare  & Medicaid Services notes in Jan. 29 Transmittal No. 1897 (CR 6791).

The problem: “When a hospice patient has different levels of care within a given month, it is sometimes not clear from the claim which visits or calls are associated with each level of care reported on the claim,” CMS explains in the transmittal. “This is because each level of care is only required to be reported once on the claim for the location it was provided and all days associated with that level of care are billed on one claim line, even when the days being billed on that line are not consecutive.”

The solution: Starting April 29, “hospice claims … should report separate line items for the level of care each time the level of care changes,” CMS instructs in a related MLN Matters article.“This includes revenue codes 0651 (Routine Home Care), 0655 (Inpatient Respite Care) and 0656 (General Inpatient Care).”

For example … (more…)

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Hospice Experience Sheds New Light On Health Care Debate

Posted on 29. Jan, 2010 by .


Oncologists, hospice providers & palliative caregivers shouldn’t miss this eye-opening op ed piece.

While most Americans fretted about the ‘death panel’ discussions that surfaced during last year’s health care reform debate, hospice providers — and perhaps the patients and families they served — might have had a different perspective.

In a recent opinion piece published in The Los Angeles Times, columnist Meghan Daum ponders how ‘hope, medicine and managing death’ converged for her against the backdrop of the health care reform debate. As the politicos debated endlessly on C-Span, Daum was right in the center of a medical crisis involving her 67-year old mother, who died from stage-four gallbladder cancer the day after Christmas. (more…)

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What Home Care Coders Need to Know About ICD-10

Posted on 26. Jan, 2010 by .


With ICD-10’s 200 diabetes codes, just one code reports both the diabetes and the manifestation.

The Oct. 1, 2013 deadline may seem like a distant date, but it’s not too early to begin preparing for ICD-10 implementation. Experts advise taking advantage of the lead time you have so you’ll be truly prepared come cut-over.

Relish These ICD-10 Benefits

ICD-10 will increase our inter-operability with other countries already on the newer diagnosis and procedure coding system, says Therese Rode, RHIT, HCS-D, senior coding manager with INOVAVA Home Health in Springfield, Vir. (more…)

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Big Home Care Players Shop for Small HHAs

Posted on 20. Jan, 2010 by .


Remember the home health shakeout after 1997′s BBA? It’s déjà vu all over again.

Home care is anticipating “the largest period of consolidation in the industry’s history” as big players ready themselves to shop around for small companies to buy, Business Week reports.

Amedisys Inc. and Gentiva Health Services Inc. are on the lookout for small rivals to gobble up. The reason for the shopping spree? Home health funding cuts in the U.S. health-care overhaul, Business Week says.

With steep proposed home health Medicare cuts making their way through the House and Senate, small players are left with little choice but to entertain offers of bigger players to merge or consolidate. Four of those big players — Amedisys, Gentiva, LHC Group Inc., and Almost Family Inc. — may expand their 12-percent stake in the nation’s 10,000 home-nursing agencies.

The impending mergers and consolidations are expected to boost company earnings, but the downside is limited choices for consumers. Worse yet, people in rural areas may lose access to home care altogether and have to choose expensive healthcare services in nursing homes and hospitals instead.

The shakeout in the home care industry is reminiscent of what happened a decade ago when the Balanced Budget Act of 1997 triggered Medicare cuts that greatly affected home care.

How are you doing this year? Ace HHA PPS in 2010. Available on CD.

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Avoid These Pressure Ulcer Land Mines On OASIS C

Posted on 13. Jan, 2010 by .


Best bet: Start by learning what stage each item asks about.

You should be hitting the pressure ulcer items heavily in your OASIS C training, or you’ll be paying the price in your reimbursement and outcomes. Don’t expect to make an easy transition from OASIS B-1 to OASIS C when it comes to the integumentary items. Twelve questions address pressure ulcers in the new assessment tool taking effect Jan. 1, and only careful reading will ensure an accurate answer.

Why worry? Imagine your clinician’s confusion when she gets to the integumentary items. Of the pressure ulcer questions:

  • M1306 (Does this patient have at least one unhealed pressure ulcer at Stage 2 or higher or designated as “unstageable”?) applies to Stage 2, Stage 3, Stage 4, and unstageable ulcers.
  • M1307 (The oldest non-epithelialized Stage 2 pressure ulcer that is present at discharge) applies to Stage 2 only. (more…)

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OASIS C Is Ready To Roll: Are You?

Posted on 16. Dec, 2009 by .


Look for changes to OASIS login, HH ABN in new year, CMS says in Open Door Forum.

In a few short weeks, your OASIS C rubber will be hitting the road. Home health agencies secretly wishing for a Christmas miracle of delayed OASIS C implementation will be disappointed. The Centers for Medicare & Medicaid Services is moving ahead with Jan. 1 implementation for OASIS C as planned, CMS’s Debbie Terkay said in the Dec. 2 Open Door Forum for home care providers.

HHA clinicians will encounter a number of confusing OASIS C obstacles, which may not be helped by the guidance issued by CMS itself. (more…)

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HHA Reimbursement: Minimize Your Outlier Risk With These 7 Steps

Posted on 16. Dec, 2009 by .






Discharging patients to comply with outlier cap may open you up to abandonment charges.Tough times are ahead for home health agencies affected by the 10 percent outlier cap. Here are steps you can take to mitigate the policy’s impact on your agency:

1. Assess your vulnerability. The 10 percent per agency cap will start applying immediately in January. That means you need to find out right away if your payments will be limited, recommends Abilene, Texas-based financial consultant Bobby Dusek.

“An agency can look at their total outlier payments as a percentage of their total reimbursement to see if they might have a problem,” Dusek advises. Since the cap will affect episodes that have already begun, “agencies need to look at their situation now,” he stresses. (more…)

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HHA Case Study: Use Your Therapists To Reduce Hospital Readmissions

Posted on 09. Dec, 2009 by .


Patient education is just as important as your therapists’ education.

With your patient outcomes and even survey results on the line, curbing hospital readmissions should be at the top of your to-do list. And with pay for performance expected around the corner, reducing readmits will become even more crucial.

Your team of therapists can help your home health agency be the exception to the rule with the right tools, industry experts say.

Know Your Biggest Risk Stats

Your HHA should be keeping track of its top reasons for readmissions and target those in staff training. For example, Amedisys Inc., an HHA chain based in Baton Rouge, La., found that falls were one of its biggest culprits for hospital readmissions.

“So we’ve had a big push in the company to identify fall risk factors, educate the community and our personnel, and follow up with focused interventions,” says therapist Kim Marryott Lee, corporate director of rehab research and quality for Amedisys. (more…)

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Home Health Coding Challenge: Double Diabetes, Hybrid Diabetes

Posted on 24. Nov, 2009 by .


If you see this dinosaur phrase in the documentation, query the doctor to code correctly.

Question: What kind of supporting data do I need to assign a Type 2 diabetes code for the phrase, “insulin dependent diabetes”? I have this note that only states “insulin dependent diabetes” as a diagnosis. There was no mention as to controlled or uncontrolled, or Type 1 or 2. So I queried the physician. His response is: “The patient is neither type but in between.” How should I code this diagnosis?

Answer: There is a new kind of diabetes called Type 3 or Type 1½. The phenomenon is also known as “double diabetes” or “hybrid diabetes,” and it’s harder to diagnose and significantly more difficult to treat, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, Texas.

Have you heard on ‘Type 3′? Read on … (more…)

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Does Debridement Change Pressure Ulcer Coding for Home Health?

Posted on 10. Nov, 2009 by .


Question: Is a debrided ulcer considered a nonhealing chronic wound or is it a nonhealing surgical wound?

Answer: You should consider a debrided ulcer to be an ulcer and code it as such. Debridement does not make the ulcer a surgical wound. The best strategy is to go with the wound’s origin.

For example, your patient has a previously staged stage IV pressure ulcer on the hip covered with eschar and slough. She undergoes sharp debridement. You would still code the wound as a pressure ulcer. Debridement is an ulcer treatment and does not make the pressure ulcer a surgical wound.

So, at first you would code for the pressure ulcer with 707.04 (Pressure ulcer; hip) and 707.25 (Pressure ulcer, unstageable). After the debridement, you would report the pressure ulcer with 707.04 and 707.24 (Pressure ulcer stage IV).

© Home Health ICD-9 Alert.

AUDIO LEARNING OPPORTUNITY. One wrong assumption about wound care coding could cost your HHA thousands. Learn about pressure ulcer staging, documentation requirements and more. With Tricia A. Twombly, BSN RN HCS-D, CHCE.

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