Archive for 'Hot Topics'

Don’t Let A Subcontractor’s False Claims Tank Your HHA’s Compliance

Posted on 04. Nov, 2009 by .


Audit and monitor your staffing arrangements — before the feds do.

Just when you thought compliance with the False Claims Act (FCA) put enough on your plate, Congress has passed another rule that could leave you in regulators’ crosshairs.

As part of the follow-up to the 2009 stimulus package, Congress passed the Fraud Enforcement and Recovery Act (FERA), which expands the FCA’s reach in three critical areas: subcontracting, Medicaid, and overpayments, according to Robert W. Markette Jr., a partner with Gilliland & Markette LLP in Indianapolis.

Bad news: FERA provides “an even larger hammer to hit providers with,” Markette told listeners in the Eli-sponsored audioconference, “Prepare for Unseen Liabilities: FCA, FERA, and Their Impact on Health Care.”

But your agency doesn’t have to take the hit, Markette assured conference participants. Here’s how the FCA will affect you — and what you can do to stay on regulators’ good side.


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Home Health Coding Coach: Late Effects ICD-9 Tips

Posted on 27. Oct, 2009 by .

Coding aces know that rules get turned upside down sometimes.

Coding aces know that rules get turned upside down sometimes.

Late effect of CVA turns guidelines upside down.

When coding for late effects, sequencing is everything. Keep one rule of thumb and two exceptions in mind and you’ll be accurate every time.

Here’s When to Report Late Effects

A late effect is the condition produced after the acute phase of an illness or injury has run its course, according to the ICD-9-CM Official Guidelines for Coding and Reporting.

There is no time limit on when you can report a late effect, according to the guidelines. The residual effect of your patient’s illness or injury may be apparent early, such as when he’s had a cerebrovascular accident (CVA). Or a residual may occur months or years later, such as when your patient has had a previous injury.

Dig deeper: Frequently the original illness or injury is forgotten, says Jan McLain, RN, BS, LNC, COS-C, HCS-D, with Adventist Health System  Home Care in Port Charlotte, Fla. Identifying a true late effect can require investigation of the past medical history and targeted questioning to determine the relationship between the event from years before to the symptoms that are presenting today.

Narrow your search: Many coders aren’t sure how to find the code they need to indicate the residual effect of a disease or injury. “They’ll look under ‘syndrome’ or ‘complication’ in the alphabetic index of the coding manual,” says Trish Twombly, RN, BSN, HCS-D, CHCE, director of coding with Foundation Management Services in Denton, Texas. And there’s no section in the tabular list of your coding manual that includes all the late effects codes, Twombly notes. (more…)

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Home Health PPS 2010 Update

Posted on 21. Oct, 2009 by .


Warning: Proposed rule doesn’t give you the instructions you need for compliant skilled services billing.

Figuring out which services Medicare will pay for is a toughie — but don’t think you’ll be able to look to CMS for guidance.

In the HH PPS Update 2010 proposed rule published in the Aug. 13 Federal Register, CMS clarified coverage for evaluation and management services, something that agencies desperately need to determine whether Medicare will pay for skilled nursing and home health aide services as the primary payer, says Washington, D.C.-based attorney Elizabeth Hogue.

CMS’s clarifications don’t come out of the blue. MedPAC, the Office of Inspector General, and Medicaid state agencies have all suggested that CMS remove any doubt about how or when Medicare will cover skilled services. After working with agencies to identify what was causing the confusion, CMS proposed these changes:

• A new paragraph in Section 409.42(c)(1), which states that in the home health setting, management and evaluation of a patient care plan is considered a reasonable and necessary skilled service only when underlying conditions or complications are such that only a registered nurse can ensure that essential non-skilled care is achieving its purpose. (more…)

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Your Home Health Action Plan for OIG’s 2010 Work Plan

Posted on 14. Oct, 2009 by .


How the OIG’s plan to evaluate ‘home health agency profitability’ could hurt YOUR bottom line.

By now, everyone’s had a chance to check out the home health items the HHS Office of Inspector General will tackle in its 2010 Work plan. So what now? Attorney Robert Markette has some self-audit action items for you in his Home Care Law Blog.

Here are 5 highlights …

Action #1 — Audit your cost reports. Alarmingly, the OIG says it will move out of its compliance focus to evaluate cost report data for ‘home health agency profitability.’ “OIG does not make clear what level of profitability it will find to be acceptable,” Markette notes.

“If OIG sees what it thinks are unacceptable profits, it will add its voice to MedPAC’s cry to reduce excessive profitability by reducing rates,” Markette predicts.  ”It won’t matter if the assessment is based upon flawed cost report data” — and a large percent of cost report data is.

Experts recommend cost report best practices here. (more…)

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OASIS C: Time for HHAs to Update Flu, H1N1 Vaccine Procedures

Posted on 07. Oct, 2009 by .


Swine Flu Monitors at CDC

OASIS C will measure & report your HHA’s vaccination rates.

The 2009-2010 flu season officially begins this week, according to the Center for Disease Control and Prevention (CDC). If your home health agency isn’t completely ready, we’ll give you a ‘booster’ with some handy links.

Vaccination rates will begin receiving new scrutiny as home health agencies tackle the new process measure in the OASIS C assessments. The focus in OASIS C is on seasonal flu vaccines and the pneumonia vaccine.

AUDIO TRAINING EVENT: Vaccination rates & other OASIS C process measures. October 22, with Judy Adams.


While the flu season has started early this year in all 50 states, most of the cases so far are of the H1N1 variety (so-called swine flu), reports Dr. Daniel Jernigan, deputy director of the influenza division at the CDC. (more…)

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Home Health Coding Education: ICD-9 2010 Made Simple

Posted on 30. Sep, 2009 by .

Photo: Wikipedia, KMJ

Photo: Wikipedia, KMJ

Learn how to use the new codes for carcinomas, secondary neuroendocrine tumors, gouty arthropathy, brain injuries & more.

It’s that time of year again — are you ready for the new and revised 2010 ICD-9 codes? Make sure you know which changes are most likely to impact your home health agency.

The changes, announced by the Centers for Medicare & Medicaid Services (CMS) are effective Oct. 1 with no grace period. The good news: You’ll have fewer changes to master this year than you did last year, said Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C. during a recent Eli-sponsored audioconference. This reduction in changes may be a trend we’ll continue to see as we ramp up for ICD-10, she says.

Welcome More Specific Neuroendocrine Tumors Codes

Look for six new codes for Merkel cell carcinoma at 209.3x (Malignant poorly differentiated neuroendocrine tumors). These additions expand on the 209.3x subcategory that was added last year, along with the 209.xx (Neuroendocrine tumor) category. These neoplasm case mix category welcomes the six new codes: (more…)

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Hospice Compliance: How to Get Unused Controlled Drugs Out of the Home

Posted on 23. Sep, 2009 by .


This task is fraught with regulatory and safety concerns.

Leaving scheduled meds in a hospice patient’s home after he dies opens the door to potential drug diversion or accidental poisonings. Getting the medications out of the house, however, requires a mixture of regulatory and legal know-how, as well as awareness of environmental concerns.

The regulatory reality:

“Technically, once the drugs are prescribed and in the patient’s home, they are the patient’s property, says Janet Neigh, VP for hospice with the National Association for Home Care & Hospice. And “hospices are required to have policies and procedures for disposing of controlled substances after a patient’s death that include taking an inventory of the drugs that are left in the home, and the manner of disposal,” says Marie Berliner, an attorney in Austin, Texas. (more…)

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Hospice Regulation: Take The Sting Out Of New Physician Narrative Requirement

Posted on 16. Sep, 2009 by .


Hospices can get physician buy-in with a few simple strategies.

Ready or not, hospices have less than a month to comply with the new hospice narrative requirement —and physicians aren’t likely to make it easy on you.

As first proposed in April, the CMS has adopted the Medicare Payment Advisory Commission’s recommendation that physicians include “a brief narrative explanation of the clinical findings that support a life expectancy of [six] months or less” when they certify (or recertify) hospice patients as being terminally ill.

Published in the Aug. 6 Federal Register, the final rule does include a few key changes from the original proposal. (more…)

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The Latest on Palliative Care Drugs

Posted on 09. Sep, 2009 by .


As few as 6-15 of these caplets can cause lethal overdose.

If you’re not up to speed on the latest for palliative care drugs, here’s how you can get a quick overview on newbies like Tapentadol, Zolpimist Nasal Spray, and Savella — plus can’t-miss new information on older drugs like Phenergan, Propoxyphene and tamper-resistant opiods.

When evaluating a palliative care drug, it’s important not only to consider its effect, but also its “burden-to-benefit” ratio, Dr. Lynn McPherson told attendees at an American Academy of Hospice and Palliative Medicine conference. Take into account drug cost and side effects as well, she advised.

Handy Tool: Dr. McPherson’s comments on the newest drugs are summarized in this handy table recently published in Oncology Nursing News. Other highlights from Dr. McPherson’s talk, according to ONN:

  • Although it’s not regulated as a controlled substance, Tramadol should be “on nurse’s radar screens” because patients can become physically or psychologically dependent on it.
  • If you’re thinking promethazine (Phenergan) boosts an opiod’s ability to relieve pain, think again, Dr. McPherson advised. One study found the drug actually increased pain sensitivity and the need to opiods.
  • “As little as 6 to 15 tablets or capsules of [propoxyphene] can be lethal, Dr McPherson indicated at the meeting, especially when it is used with alcohol or central nervous system depressants,” ONN notes. “Propoxyphene plus acetaminophen doesn’t offer additional pain relief as compared to acetaminophen alone, she concluded.”

If you’re looking to stay updated on new drugs, many of which are relevant to hospice and palliative care, you can check out this FDA site and sign up for email alerts … More details from Oncology Nursing News.

Available on CD: Palliative Care for Hospice — The Regulatory Possibilities & Pitfalls. With Mary Michal.

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Study: When Insurers Cooperate, Hospice Utilization Doubles

Posted on 02. Sep, 2009 by .


What palliative care providers can learn from one insurer’s case management model.

Hospice benefits are underutilized in this country, and there are many complex reasons for that. But a new study published in the Journal of Palliative Care has shown that hospice utilization more than doubled among a group of Aetna benes after the insurer began to feature palliative care options in its case management program. And, increased case management hospice utilization didn’t significantly increase costs to the insurer, the study concludes.

You can read all about the study design, results and patient populations served by reading the research article and perhaps, sharing it with your payers.

What strikes us here at Homecare & Hospice News the case management model the study describes, which has some neat takeaways for most palliative care providers:

  • The study’s authors identified potential hospice patients by pulling claims that indicated terminal illness. Some benes declined the hospice benefit.
  • Nurse case managers received special training in palliative care, and hospice case management was provided in addition to other case management services relevant to the disease involved.
  • Case managers educated physicians about the hospice case management program via an insurer newsletter, and telephoned patients and families to tailor a case management approach for each patient.
  • Case managers worked with about 40-45 patients at a time, all in various stages of hospice. The cost to the insurer for a hospice nurse manager averaged to $400 per patient.
  • Later in the study, hospice services were expanded by cooperating with 13 large employers. For example, maximum dollar limits for outpatient hospice were removed.
Now available on CD: Hospice business ventures — how to seize opportunities and stay compliant. With attorney Bob Markette.

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