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Polish Your Hospice GIP Documentation Skills

Posted on 26. Aug, 2009 by .

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Now’s the time to make sure your hospice general inpatient (GIP) claims will pass muster with reviewers. A recent whistleblower lawsuit highlights GIP’s status as a hospice hot spot.

While reviewers haven’t made GIP care review as high a priority as they could have, they are probably looking harder at documentation for the level of care compared to previous years, says Jay Mahoney, a consultant with Summit Business Group in Penfield, N.Y.

As with so many reimbursement and compliance issues, a hospice’s GIP fate relies heavily on the quality  of documentation in the patient record, experts agree. If documentation does not support eligibility for GIP-level care, “then it does not matter whether the patient was eligible or not,” cautions consultant Heather Wilson with Weatherbee Resources and the Hospice Education Network in Hyannis, Mass. “The hospice can’t prove it if it is not documented.”

“It actually just comes down to one word — documentation!” stresses consultant Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. Improving and perfecting documentation is a simple concept but a difficult challenge to execute, Wilson acknowledges. “It all comes back to the same thing — what does the medical record say — or not.”

Tip: Wilson recommends working with all levels of hospice clinical staff, from the medical director to the aides, to “know the importance of documentation and how to document accurately, thoroughly, and clearly in each patient’s clinical record.”

It’s irrelevant whether the person reviewing your claim and medical records is from the intermediary, the OIG, the U.S. Attorney’s Office, the Recovery Audit Contractor, etc. in response to an audit, probe edit, an investigation, a whistleblower lawsuit, or whatever, Wilson notes. “It does not matter – the only evidence they have to go on is the medical record.”

Do this: For GIP care specifically, “the documentation must clearly demonstrate the patient’s need for this more intensive level of care,” Adams advises. And it must show the skilled services provided relate to the reason the GIP care is necessary. “Clinical notes cannot read like the ones when a patient is in routine home care,” Adams warns. “They should focus on the short-term acute issues that necessitate the hospital stay and what is being done to address those needs.” They should also show discharge planning to return the patient to routine home care.

Consider Daily Review for Inpatient Stays

Consultant Beth Carpenter with Beth Carpenter & Associates in Barrington, Ill. and Samira Beckwith with Hope Hospice and Community Services in Ft. Myers, Fla. recommend a daily review to assess whether patients continue to qualify for the higher level of care, which should also be documented.

Bottom line: “The key is the description of the patient’s condition with articulate, objective, supportive documentation,” Carpenter concludes. “Each note for inpatient care should clearly show the necessity for the inpatient level of care, the actions being done to control the identified problem/issue, and the progress toward return to routine home care,” Adams adds.

Red flags: You may have a tough time defending your claims if your records have one of these common pitfalls, Adams says: * “Long lengths of stay in inpatient units; * Moving the patient to less intensive areas like step-down units;

* Documentation of custodial care;

* Documentation that reflects the same type of care/services as routine home care.”

Beware: Increased scrutiny of GIP care has Beckwith worried that the service will be underutilized by cautious hospices, resulting in beneficiaries who have trouble accessing a needed service. “We don’t want people to get scared and not provide it,” she tells Eli’s Hospice Insider.

© Eli’s Hospice Insider.

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Less End-of-Life Depression, Anxiety at Mother House

Posted on 08. Jul, 2009 by .

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“They have better deaths than any I’ve ever seen,” says Dr. Robert C. McCann, a geriatrician at the University of Rochester. Who are these people, where is this place, and what can home care and hospice professionals learn from it?

Welcome to Mother House, a community for elderly nuns who have spent their lives with Sisters of St. Joseph in Rochester, NY. Many sisters are aging, and one dies each month at Mother House — not the hospital, reports The New York Times. “There is a time to die and a way to do that with reverence,” says caregiver Sister Mary Lou.

The sisters’ belief in the afterlife lessens the anxiety and depression some end-of-life patients experience. Dr. McCann reports that he administers one-third fewer narcotic painkillers to Mother House hospice patients than patients he sees outside the convent.

Being surrounded by people who knew them earlier in life also helps Mother House residents. For example, there is someone to remind one sister with Alzheimer’s that she was once a high school principal … More from The New York Times.

New publication: Hospice Insider.

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Overutilization? What Home Care Providers Need to Know About McAllen, Texas

Posted on 18. Jun, 2009 by .

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What’s so special about McAllen, Texas? Smart home care providers should make it their business to know.

A recent New Yorker article about health care utilization patterns in the Texas border town has become required reading for health reform wonks in the White House. President Obama himself has mentioned the article in several recent speeches.

And some who’ve read the article are likely to propose tighter referral regulations. Look for Stark and anti-kickback safe harbors to get smaller if the health reformers have their way.

The article’s author, Dr. Atul  Gawende, took a look at McAllen to try and figure out why health care spending there was just about the highest in the nation, and why Medicare spent $15,000 per bene there in 2006–twice the national average.

Home care is part of McAllen’s overutilization problem. “Compared with patients in El Paso [a similar market] and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care,” Gawande points out. ”And Medicare paid for five times as many home-nurse visits.” Despite higher costs, outcomes were no better than other markets, Gawande convincingly argues.

As part of his research, Gawande interviewed McAllen home care providers who felt pressured to offer doctors substantial perks in exchange for referrals … More from The New Yorker article …

Download an NPR Fresh Air podcast featuring an interview with Dr. Gawande …

The regulations right NOW are confusing enough. Attorney Robert Markette teaches you how to seize hospice business venture opportunities and still stay compliant. An AUDIO training event.

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Quality Outcomes Alert: Ask New Patients This Question

Posted on 17. Jun, 2009 by .

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Got oxygen?

That’s the question you should be asking new patients. Ever since Medicare tightened reimbursement rules for home oxygen therapy this past January, patients have had a heck of a time when they switch suppliers, The Wall Street Journalreports.

Why do patients switch suppliers? Because they’re moving to a new location, and this move also involves a move to a new HHA. If patients who need oxygen aren’t getting it, that makes outcomes that much harder for the HHA to achieve, says OASIS Alert editor Marian Cannell. The unintended results of the new reimbursement rule could potentially stall improvement in bathing, dressing, ambulation, wound healing, pain management and even rehospitalization, she adds.

The root of the problem: Oxygen suppliers just aren’t taking on patients who are close to the three-year Medicare reimbursement limit, and they’re cutting back on respiratory therapists as well … More from The Wall Street Journal

Are you ready for the OASIS C rule in January? We’ve got just the boot camp you need to prepare.

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Avoid These Hospice Eligibility Pitfalls

Posted on 28. May, 2009 by .

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If your hospice hasn’t taken a good look at how it determines–and documents–patients’ eligibility for the Medicare hospice benefit, you’re fair game for everything from payment recoupments to fraud and abuse investigations.

There’s no shortage of reasons for hospices to pay close attention to patients’ hospice eligibility, an issue that has moved to the front burner for payers and prosecutors.

First, there’s the specter of the $24.8 million SouthernCare qui tam lawsuit settlement involving allegations that the hospice kept patients on the benefit who didn’t need it.

Experts also predict the Recovery Audit Contractor program will likely target the hospice eligibility issue, which provides easy pickings.

Not only that: Providers that consistently have longer-than-average lengths of stay will likely prompt a medical review, if a hospice shows persistently higher-than-average LOS compared to what the CMS reported as the average, predicts consultant M. Aaron Little with BKD in Springfield, Mo.

AUDIO TRAINING EVENT: What every hospice should do at the onset of a probe edit – even if you aren’t in the wrong. With attorney Mary Michal.

“The longer lengths of stay are not only an issue from a medical review perspective,” adds Little. They “can also put a provider in a situation where it exceeds the per beneficiary cap, which is an average over the reporting year.”

And hospice eligibility is a favorite target for surveyors, experts point out.

One Trajectory Doesn’t Fit All Patients

Hospice teams tend to do “snapshot documentation”about the hospice visit where the interdisciplinary group members describe what they saw and did for the patient, says consultant Joy Barry with Weatherbee Resources in Hyannis, Mass. But that approach doesn’t provide “a good picture — painted in words – of the patient’s trajectory of illness over time,” Barry cautions. (more…)

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