Archive for 'Money Matters'

Hospices Must Provide Even More Claims Data

Posted on 02. Mar, 2010 by .


This spring, hospices must provide yet another piece of data on 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 …


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HHAs Save On Fuel With These 11 Tips

Posted on 25. Jan, 2010 by .


Gasoline prices can cut into your HHA’s bottom line, but this savvy advice keeps your engine purring.

It still holds true today. Just a few simple steps can save your HHA tons on gas prices. We dug up this classic Home Care Week article from a couple years ago that digests the smartest tips from the industry.

1) Geographic scheduling. If you haven’t done so yet, you must get deadly serious about scheduling visits as efficiently as possible, experts agree. Larger agencies that can assign whole teams to a geographic region will fare better with scheduling visits efficiently, notes consultant Betty Gordon with Simione Consultants in Westborough, MA.

“I have always seen a lot of back-tracking and sending someone across town and back again on one day to see patients that are in the same geographic area,” observes consultant Jim Hamilton with David-James in Baltimore. HHAs “need to have well defined areas and manage the schedules instead of allowing the employees to manage them.”

When visits are scheduled geographically, some employees can carpool to patients’ homes, notes Karen Hinkle with the Kentucky Home Health Association.

2) Keep visit times, staff flexible. The best way to make scheduling most efficient is to allow for variations in visit times and staffing. However, that can be difficult when patients prefer certain staff and visit times, notes Dan Hull with the Utah Association for Home Care.

HHAs should reiterate that they have never been able to promise a certain visit time, unless it is a time-sensitive treatment, Hamilton urges.

4) Cut down on unnecessary visits. Review care plans and schedules to identify and eliminate unnecessary trips to patients’ homes, recommends consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT.

3) Use telehealth. A prime way to avoid unnecessary visits is to implement a telehealth program. “High gas prices make clear that payment for telemedicine is past due,” notes Peter Cobb with the Vermont Assembly of Home Health Agencies.

But there are some big obstacles to telehealth implementation. Many agencies don’t have the money for the initial investment such systems require, notes Casey Blumenthal with MHA…An Association of Montana Healthcare Providers.

Plus many agencies don’t like that Medicare doesn’t recognize their telehealth costs on the cost report, even if the prospective payment amount for a patient served by telehealth remains the same. And for HHAs with significant managed care contracts, often managed care organizations pay for home care by the visit and don’t reimburse anything for telehealth, Gordon notes.

4) Give the gift of gas. HHAs that don’t want to raise mileage reimbursement rates but want to ease employees’ gas-related burdens often are turning to gas gift cards, reports Marcia Tetterton with the Virginia Association for Home Care.

“Although this doesn’t fully compensate for the huge jump in prices, it demonstrates that the agency is concerned about [employees’] increased costs and is willing to share the burden,” Hamilton says. “If gas prices come down to reason, then the agency may decide to no longer issue the gas cards.”

5) Review mileage records. You can help economize on gas prices by reviewing the mileage records of those staff who incur the most miles, Hamilton suggests. “Look carefully at their itineraries to see if efficiencies can be obtained.”

6) Pay up to the limit. If your budget can swing it, reimbursing up to the IRS limit is the simplest way to ease employees’ fuel burdens without adding to their taxable income, notes consultant Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas.

7) Offer extra payment. If you already pay up to the IRS limit, you can still offer extra reimbursement. HHAs are offering per-visit add-ons of $1 to $3 when gas prices skyrocket, Boyd notes. And one of Hamilton’s clients offers a $250 per year stipend to help offset the cost of operating a vehicle.

However, be aware that such payments are counted as employee compensation and thus are taxed, labor law experts warn.

8) Use company cars. Thanks to the fuel increase, HHAs have started using more company cars for employees to drive, Hinkle notes. Being thus prepared has helped some agencies with the latest fuel price increases.

This strategy can be a valuable recruitment and retention tool, Gordon notes. And a fuel-efficient fleet may achieve significant savings over employees’ own gas guzzlers.

Tip: HHAs that use agency-owned cars should be “very specific about the caseload and productivity expectations,” McNamara advises.

9) Educate staff. Saving on gas can be a team effort. Munson Home Care and Home Services in Traverse City, MI includes gas conservation ideas in its employee bulletin, reports director Linda Rutman. You can find tips on Web sites such as, and

10) Avoid unnecessary travel. In addition to cutting out extraneous visits to patients’ homes, agencies should also seek to eliminate unnecessary visits to the office, McNamara urges. That may mean using automation to avoid dropping off paperwork, for instance.

Munson Home Care conducts branch meetings via teleconference instead of in person, when appropriate, Rutman says.

11) Step up lobbying. When gas prices are highest is the time to remind lawmakers that home care needs adequate funding to provide a vital service. That may involve lobbying state legislators for Medicaid increases, says Brian Ellsworth with the Connecticut Association for Home Care & Hospice. Or it may mean lobbying state and federal legislators for telemedicine funding, Hull adds.

Did you know that past issues of Eli’s Home Care Week are chock-full of tips you can use anytime? And the whole collection is keyword searchable for one low monthly price. Visit Home Care Connection to learn more.

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Will Enteral Nutrition Suppliers See Reimbursement Cuts?

Posted on 20. Jan, 2010 by .


Medicare’s fee schedule amounts exceed available market prices for ENT.

Suppliers of enteral nutrition might have a harder time arguing against competitive bidding or other payment-rate-reducing mechanisms, thanks to a new report from the OIG.

In a review of Part B enteral nutrient payments during non-Part A nursing home stays in  2006, the OIG found that Medicare’s fee schedule amounts for nutrients exceeded prices available to nursing home suppliers and other purchasers by more than 50 percent.

Based on OIG’s calculations, Medicare’s allowance for two of the most frequently billed enteral nutrient codes (B4150 and B4154 nutrients) exceeded supplier prices by approximately $61 million for non-Part A nursing home stays in 2006.

Background: Medicare Part A covers nursing home care for up to 100 days in a SNF, during which time Part A pays for ENT as part of the nursing home’s daily rate. After the 100 days, or in cases when beneficiaries do not qualify for Part A stays, Medicare Part B covers enteral nutrients, supplies, and equipment. (more…)

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Health Care Reform Update: Home Care Cuts Advance in Congress

Posted on 05. Jan, 2010 by .


Senate passes billions in reimbursement cuts.

Congress has yet to pass the final word on home care cuts this year, but the outlook is grim.

On Christmas Eve, the Senate approved massive health care reform legislation which includes cuts to home health agency and hospice reimbursement levels under Medicare. The Senate legislation would cut HHArates by $39 billion over 10 years, notes the National Association for Home Care & Hospice. That’s nearly $3 billion less than first proposed, thanks to some last-minute amendments from home care-friendly Senators. (more…)

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Home Health CODING: Double-Check Documentation or Risk Low Vision Downcoding

Posted on 09. Dec, 2009 by .


Case mix diagnosis bring claim scrutiny.

Auditors are looking closely at claims with low vision diagnoses. Keep a sharp eye on your documentation to ensure it contains the essentials required to earn reimbursement for this case mix condition.

Low vision has been a problematic diagnosis for a while, says Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C.

When coding for low vision, make sure you’re also listing the diagnosis code for the condition responsible for the low vision, Adams says. For example, list 362.50 (Macular degeneration [senile], unspecified) along with the appropriate code from the 369.xx low vision category if macular degeneration caused your patient’s vision trouble.

Next: The big mistake most home health coders make … (more…)

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2009′s Oxygen Squeeze Takes Toll On Suppliers, Patients

Posted on 24. Nov, 2009 by .


Medicare may be saving more on oxygen, but it’s paying more in hospital stays, experts contend.

Home care and durable medical equipment industry vets saw it coming back when a punishing new oxygen payment rule took effect this past January. Oxygen suppliers are turning away new patients or going out of business as a result of the new rule, and patient hospitalization for problems such as emphysema and COPD are trending up as oxygen gets harder for some to find, reports The Wall Street Journal.

Summary of the oxygen reimbursement rule: “Medicare pays suppliers at the prevailing rate—an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage,” explains the Journal. “Suppliers are then required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After that, patients are entitled to receive new equipment, and Medicare will resume paying suppliers at the higher rate.”

4 Results of the year-old rule so far:

1. CMS expects to save $220 million on oxygen this year. (more…)

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Final 2010 Home Health Service Rates Available

Posted on 11. Nov, 2009 by .


Watch Out: Congressional action could cut rates in near future.

As we mentioned last week, CMS issued the final home health prospective payment system update on Oct. 30. This week, we’ve got some preliminary analysis and handy advice from OASIS Alert editor Marian Cannell.

What Marian wants you to know up front and center? “Make sure you have the latest — and most accurate — version of software and instructions,” she stresses.

Dollars & Cents Summary: The final rule implements a 2 percent market basket update, a scheduled 2.75 percent “case mix creep” subtraction, and a new outlier policy that adds 2.5 percent to the base rate. This sets the overall base rate increase at 1.75 percent for calendar year (CY) 2010. The base episode rate for 2010 will be $2,312.94. The low utilization payment (LUPA) add-on will be $94.72.

The PPS rule contains a number of other ‘heads up’ rules and measures, which Marian lists here … (more…)

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Home Health Coding: Gather Details for COPD Case Mix Points

Posted on 04. Nov, 2009 by .


Question: Your 82-year-old patient lives alone and has a history of falls. He was admitted to home care for severe pain due to osteoarthritis in bilateral knees. You will be providing physical therapy and skilled nursing. He also has a history of diabetes with numbness and tingling to bilateral lower extremities, which the physician has confirmed is diabetic neuropathy. He also has hypertension (HTN).

Answer: List the following codes for this patient, says Cherlynn Taylor, senior coding coordinator with The National Coding Center in Troy, Mich:

Upon reviewing the patient’s medication, the nurse finds two inhalers with recent start dates. Checking with the physician, she finds that they are for asthma with chronic obstructive pulmonary disease (COPD). How would you code for this patient?

M0230/M1020a: 715.36 — Osteoarthrosis, localized, not specified whether primary or secondary; lower leg

M0240/M1022b: 250.60 — Diabetes mellitus with neurological manifestations; type II or unspecified type, not stated as uncontrolled (more…)

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MARKETING: Start the Conversation to Get Providers and Consumers Talking About Hospice

Posted on 27. Oct, 2009 by .


One hospice shares what they found works well.

The right educational approach can help providers and consumers realize that hospice can be an answer to end-of-life care needs — not a topic to avoid discussing.

That’s not to say that you don’t sometimes have to break the ice to get people, including doctors, nurses, and social workers, comfortable addressing the topic. Hospice “has such a stigma attached to it that no one ever really wants to talk about it much,” says Noelle Berardi, RN, with Samaritan Hospice in Brockton, Mass.

Yet, “the more you initiate conversation about what’s going on with a provider’s patients and what challenges they are facing, the easier it is to talk about hospice and end-of-life care.”

Talking point: “You have to give providers some way to initiate the conversation with patients,” Berardi adds. Try asking patients what they understand about their diagnosis, she suggests.

Additional Strategies Promote Dialogue … (more…)

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6 Common Cost Report Mistakes Hurt Home Health Reimbursement

Posted on 14. Oct, 2009 by .


Shoddy cost report data torpedoes industry reimbursement.

If you’ve been cutting corners on your Medicare cost report, you might as well hand law and policymakers the ax to chop your payment rates.

Legislators and policymakers at CMS, the Medicare Payment Advisory Commission (MedPAC), and other government entities rely on the cost reports to make critical payment decisions. Now that the HHS Office of Inspector General is looking to throw its two cents in on ‘home health agency profitability,’ it’s more crucial than ever that HHAs get their cost reports in order.

The problem: Due to home health agencies’ cost report errors, CMS can’t use nearly one in four cost reports home health agencies submit for prospective payment system costing information, according to the National Association for Home Care & Hospice.

Many of the cost report errors are “egregious,” notes consultant Mark Sharp with BKD in Springfield, Mo. “In our national home health Medicare cost report database … we have to purge nearly 1,800 cost reports due to incomplete data,” Sharp told Eli’s Home Care Week earlier this year. That’s more than 20 percent. Conclusions MedPAC draws from the faulty cost report data are particularly dangerous. The influential advisory body to Congress has recommended HHA cuts for years based on the information.

Make sure your agency isn’t committing one of the most common cost report sins experts see:

1. Missing data. Cost reports BKD bounces from its database are missing vital information such as home health visit data, episode data, and even cost data, says Sharp, who is serving on NAHC’s Home Care and Hospice Financial Managers Association’s Medicare Cost Report Task Force. (more…)

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