Archive for 'Money Matters'
Posted on 21. Apr, 2010 by jan.mater.
With all the focus on OASIS C process measures and communication requirements, accurate coding can get lost in the shuffle. Now more than ever, it’s important to accurately document all the factors and co-morbidities that can impact the care you provide on the OASIS. But precise diagnosis coding is just one part of the puzzle.
Before OASIS C, it was somewhat easier to see how the diagnosis codes you chose would impact your agency’s reimbursement. Now, coding by itself doesn’t often make the difference in dollars, says Jan McLain, RN, BS, LNC, HCS-D, COS-C with Adventist Health System Home Care in Port Charlotte, Fla. Instead, code selection and correct OASIS scoring — both supported by clinical documentation —combine to present a solid picture of the care you provide. (more…)
Posted on 14. Apr, 2010 by jan.mater.
The Centers for Medicare & Medicaid Services (CMS) has released quality standards that suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must meet if they’d like their Medicare reimbursements to be hassle-free.
The beneficiary protection and safeguard requirements are described in a special edition article in MLN Matters, and specifically relate to respiratory therapy equipment, PMDs, and other related durable medical equipment. They are designed to protect Medicare beneficiaries who receive DMEPOS items from the suppliers. (more…)
Posted on 07. Apr, 2010 by jan.mater.
Getting physician signature on the plan of care (POC) rule is a long-standing home health billing requirement, but in day-to-day practice it can get overlooked. Now’s the time to ratchet up your attention to this detail — or risk claim denials. (more…)
Posted on 07. Apr, 2010 by jan.mater.
There’s been a general rumbling in the hospice community of late — census numbers are dropping or leveling off. Have you been impacted?
Economy, Medicare Regs Likely to Blame
Determining precisely what is causing the decline is hard to say, but many experts believe the current economic system is playing a part. If people are reluctant to spend on optional medical care, and to put off necessary medical care, physicians and hospitals may have begun to feel the pinch, resulting in a trickle down effect of lower hospice referrals. (more…)
Posted on 24. Mar, 2010 by .
Sole nursing visit denials may be more common, but sole medical social worker visit problems can cost you a pretty penny too when they result in LUPAs.
Medical reviewers for regional home health intermediary Cahaba GBA denied 76 percent of claims with one MSW visit making up one of five visits on the claim, Cahaba says in its March newsletter for providers. (more…)
Posted on 24. Mar, 2010 by .
If you don’t take the time to make certain you’re selecting the most accurate fifth digit up front, you’re likely to wind up with delayed or denied claims. Accurate ICD-9 coding depends on coding the highest level of specificity and taking the time to find the right fifth digit will help you meet the mark every time.
Avoid This Seemingly Easy Fix
It can be tempting to simply fill in a 0 or 9 when you’re uncertain about the correct fifth digit, but doing so changes the code’s meaning. A “0” in the last digit often indicates an unspecified condition — meaning the medical record doesn’t provide enough information to allow you to select a more specific code. On the other hand, reporting a “9” for the lastdigit can indicate that the patient’s condition was specified in the medical record, but there is no ICD-9 code to report the diagnosis. Listing the fifth digit 9 indicates an “other specified” condition.
Guess what? (more…)
Posted on 17. Mar, 2010 by .
The HHS Office of Inspector General has just released its Compendium of Unimplemented Recommendations for 2010. How’s that for a mouthful? And though the longwinded title sounds positively snooze-inducing, DME suppliers who want to protect their bottom line should wake up and take a look.
Formally known by a much catchier title — The Red Book — the Compendium is the OIG’s annual list of rules they think government regulators should make stricter or enforce more vigorously to save money and reduce fraud.
Shorten oxygen equipment rental from 36 to 13 months, this year’s Compendium recommends. “If Medicare rental payments for oxygen concentrators were limited to 13 months, the program and its beneficiaries would save about $3.2 billion over a period of 5 years,” the OIG claims.
Posted on 11. Mar, 2010 by .
A picture is worth a thousand words, so just imagine how clear and helpful it could be when you’re dealing with wound care — especially when you’re trying to supplement your outcomes and reap full reimbursement for your hard work.
Consider this: Many items (like M1308,M1304, M1342, and M1350) ask specific questions about patients’ wounds. Other items (such as M2100 and M2250) want information about your agency’s treatment and care plans. Your written documentation does a wonderful job of recording all the details of your patient care, but a photograph does what all the writing in the world can’t — provide visual proof of your efforts.
Learn The Whys — & Why Nots — Of Photography … (more…)
Posted on 03. Mar, 2010 by .
Question: Our patient has multiple diabetic ulcers on his toes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetic retinopathy, and stage 3 chronic kidney disease due to the diabetes. Our focus of care is the ulcers, but the CHF and COPD also require intervention. How should we code for him?
Answer: Code for this patient as follows, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, Texas:
• M1020a: 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled); (more…)
Posted on 02. Mar, 2010 by .
Suppliers will need to keep closer tabs on their patients under a new edit that will take effect July 6.
Under the edit, the Medicare claims system will reject DME claims when the beneficiary was in a non-covered skilled nursing facility stay at the time the equipment was furnished, CMS says in Feb. 5 Transmittal No. 637 (CR 6695).
The Medicare DME benefit only applies in the home, CMS points out in the transmittal. “SNFs and dually-certified nursing homes (those certified for both Medicare and Medicaid) never qualify as a beneficiary’s home because they provide primarily skilled care or rehabilitation services.”
DME Suppliers watch out: The edit will take back money already paid to you if a conflicting SNF stay is later found in the system.