Archive for 'Tool Kit'

Home Health Coding: 3 Steps Pinpoint The Correct Dementia ICD-9

Posted on 20. Oct, 2009 by .

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Hint: You’ll never report 294.1 alone.

If your patients’ physicians are like most, they document that patients have dementia but don’t provide specifics about the type or cause.

Problem: Without specifics, you are likely under-reporting patients’actual conditions. Follow this expert advice for greater dementia coding accuracy.

1. Go Back To The Source

If the physician determines that the patient has dementia and that’s all you have documented, report 294.8 (Other persistent mental disorders due to conditions classified elsewhere, or dementia NOS), says Lisa Selman-Holman, consultant and principle of Selman-Holman & Associates in Denton, Texas.

Symptom coding tip: If the doctor also lists symptoms, you should code for them separately. For example, list 297.9 (Unspecified paranoid state) for delusions. (more…)

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5 Fixes For Cost Report Breakdowns

Posted on 14. Oct, 2009 by .

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Busted-up cost reports will wreck industry-wide havoc on home health reimbursement, so now’s the time to get your cost report engine purring smoothly.

Consultant Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas offers these 5 tips for cost report success:

1. Understand accrual accounting. Using Medicare’s required accounting method isn’t optional. Providers using cash-based accounting need to learn how to do it correctly.

2. Don’t retro-fit your data. HHAs should keep a good chart of accounts as they go along. “A good chart of accounts allows the expenses to be recorded in a natural manner and [is] designed to flow into the cost report,” Boyd explains. (more…)

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Follow This Checklist To Keep Your Episodes From Overlapping

Posted on 07. Oct, 2009 by .

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These 7 steps ensure you get all the payment you’ve earned.

The last thing you need is to lose out on reimbursement because you didn’t realize a patient is receiving care from another agency.

Regional home health intermediary Palmetto GBA offers this checklist to help you smoothly admit new patients — even those transferring from somewhere else:

— Log onto HIQH by typing “HIQH” on the main screen and entering the appropriate username and password.

— Fill in the appropriate beneficiary information required on the first screen and hit ENTER. Be sure to enter the start of care date in the APP FIELD.

— Review the information found on page 3 of HIQH to determine all prior home health episodes. Be sure to print out page 3 and date stamp it for the beneficiary’s records. Should a situation arise regarding a billing conflict this information will be requested by Palmetto GBA. (more…)

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2010 ICD-9 Checklist for Home Health Coders & Billers

Posted on 30. Sep, 2009 by .

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Hint: This year’s biggest change is process-related.

Each year, CMS announces changes to the ICD-9 code set. Make sure you know how to get ready for October 1st implementation with this handy list.

The trickiest change this year doesn’t have anything to do with a new code but is instead a process issue, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principle of Selman-Holman & Associates in Denton, Texas.

The change: In past years, the effective date of the code set was based on the “from” date on the plan of care (the first date of the certification period). But this year it’s based on the date in MO090 (the date the assessment was completed). (more…)

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Hospice Documentation: Make Sure Your Verbal CTIs Contain These 7 Items

Posted on 23. Sep, 2009 by .

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Here’s what to do when you can’t get a written CTI.

A valid certification of terminal illness is vital to your claims and your compliance record, but hospices often find it difficult to obtain a written CTI two days after hospice care is initiated or recertified. That’s when you can accept a verbal CTI, notes attorney Mary Michal with Reinhart Boerner Van Deuren in Madison, Wis. However, make sure your verbal CTIs contain these 7 elements, Michal recommends:

1. Patient’s name

2. Physician’s name

3. Patient’s terminal diagnosis or diagnoses

4. Patient’s prognosis of six months or less if the terminal illness runs its normal course (more…)

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Home Health Coding Quick Start Guide: Complicated Surgical Wounds

Posted on 16. Sep, 2009 by .

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3 steps that heal your surgical wound coding woes, plus 2 scenarios to test your skills

Your patient’s surgical wound may be complicated, but coding for it doesn’t have to be. Follow three simple steps to make sure you’re accurately reporting all the care your agency provides.

1. Know When it’s Complicated

Acomplication is a problem that arises during the healing process of the initial surgical procedure which negatively impacts healing, says Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C. For example, an infected surgical wound is considered complicated.

Tip: There’s no time limit to coding a surgical wound as complicated, Adams says. Even if the complication arises some time after surgery, you can still code for the wound as complicated. (more…)

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5 H1N1 Prevention Steps for Home Care Workers

Posted on 09. Sep, 2009 by .

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Tis the season for ‘air kisses.’

What should caregivers in your HHA know about preventing swine flu? Homecare & Hospice News has rounded up some practical tips from the experts — plus the links to places that’ll keep you informed all flu season.

1. Home care workers should schedule their flu shots now. This season, health care workers will need 3 ‘flu’ shots total. One vaccination will be the usual seasonal flu shot, and the second will be a vaccination designed especially to target swine flu. The H1N1 vaccine, which should become available in October, comes in two shots, about three weeks apart. For more information, visit the CDC’s H1N1 vaccination web site.

9/11/09 Update: One of our Eli editors has received a note from the CDC that one H1N1 shot may suffice as a vaccination. This is not yet an official decision yet, so please stay tuned for updates.

2. Make sure your home care patients get their ‘regular’ flu and pneumonia shots, and check to see whether they’re on the list to get the first doses of the H1N1 vaccine. Important: Just because someone is old doesn’t mean they’re first in line to get the swine flu shot. In fact, elderly people may have more natural immunity to the disease than younger folks, explains Lori Burdoo in the Silver Spring Elder Care Examiner. (more…)

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Therapy for HHA Patients: A 5-Point Plan That Boosts Your Bottom Line

Posted on 02. Sep, 2009 by .

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Will your plans of care stand up to intermediary scrutiny? Watch for these red flags.

Incorporating therapy more consistently into your patients’ care plans can improve patient care, outcomes, and your agency’s finances.

Adhering to the traditional types of cases for therapy referrals and using physical therapists as the gatekeeper for occupational therapy and speech therapy is a mistake, experts say. So is dividing the patient in half and saying PT works with the lower half and OT with the upper half.

AUDIO: MO826 — How will it impact your therapy visits? Cindy Krafft explains.

Instead you need to focus on what the patient needs and make therapy referrals when patients have functional deficits. To maximize patient and agency success and minimize denials, consider discussing the following areas with your clinical team:

1. Changes in utilization patterns. The fastest growing group of patients by percentage is those with 20 or more visits, reported physical therapist Cindy Krafft, Peoria, Ill.-based consultant with Fazzi Associates. Many clinicians will remember the popularity of 10 visits when that number created a big jump in payment, Krafft said. Now that the prospective payment system changed therapy reimbursement in 2008, 10 visits shows up less often in episodes, but 20 visits are more common, she told listeners at the American Physical Therapy Association Annual Conference in Baltimore in June. (more…)

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OASIS: Check Out This Resource To Improve Your Rehospitalization Score

Posted on 26. Aug, 2009 by .

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Here’s how to find out which local hospitals have the highest readmission rates

Home health agencies often find that their struggle to reduce hospital readmissions collides with the hospital’s or physician’s practice patterns or needs. A new piece of public information may better align hospital and home health agency goals.

The Hospital Compare Web site has added an important measurement to its collection. Along with data showing the hospital’s 30-day mortality rate for acute myocardial infarction, heart failure, and pneumonia, you can now see the institution’s 30-day rehospitalization data for those conditions. The rehospitalization may have taken place in the same hospital or a different one. This is “a possible indicator of how well the facility did the first time around,” CMS suggests.

The risk-adjusted data represent averages over the 2005 to 2008 period for fee-forservice beneficiaries treated at short-term acute and critical access nonfederal hospitals. The national average rate of hospital  readmission within 30 days for heart attack patients is 19.9 percent as of July 2009. The national readmission rate for heart failure patients is 24.5 percent. For pneumonia it is 18.2 percent.

OASIS C tools from Pat Jump. Available on audio this month!

© OASIS Alert.

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Tackle OASIS C With These 5 Tips

Posted on 18. Aug, 2009 by .

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Do you know where your clinicians will most likely fumble assessment?

Here’s a 5-step game plan for transitioning to OASIS C by Jan. 1 — straight from the team at Eli’s Home Care Week.

1. Get on top of your data. Answering the new process-based items on the form will depend on you gathering the correct data for them, notes consultant Lynda Laff with Laff Associates in Hilton Head Island, S.C. Right now you should clearly look at how you’re going to gather the information at different assessment points (start of care, transfer, discharge, etc.).

Challenge: Figuring out how to gather information on what interventions you performed, for example, may be tricky, Laff predicts. That’s especially true for agencies using manual records systems. A thorough overhaul of your data reports may be necessary.

2. Head off ‘no’ answers to screening questions. The new OASIS C form will ask whether you screened patients for various items ranging from falls to depression. While CMS insists these items aren’t mandatory and you have a right to check the “no risk assessment conducted” option, you should think twice before doing so, Laff advises. That’s because if the patient has an adverse outcome related to the item topic, surveyors will be quick to hop on the fact that you didn’t do anything to prevent the problem. “I would never, ever want to be an agency that answers ‘no’ to any of the screens,” Laff tells Eli’s Home Care Week.

OASIS C AUDIO CRASH COURSE. Check it out here.

And down the line, your publicly reported outcomes and payment levels will be affected by the omission, CMS indicates in its March response to comments on the form. You might as well get into the habit of using the new tools before that day arrives. (more…)

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