Home Health & Hospice

The Basics about Using Ranges

Homecare Insider, March 2, 2009

Over the years, Beacon Health has confronted some persistently problematic issues.  One of those is the use of ranges.  The fact that ranges are problematic might be surprising.  After all, there are some providers who use ranges for most of their patients.  And therein lies a concern:  Ranges are not appropriate for most patients.  

Check out the language in the Interpretive Guidelines for §484.18 of the Conditions of Participation.  “Medicare orders may authorize a specific range in the frequency of visits for each service (for example, 2-4 visits per week) to ensure that the most appropriate level of service is provided to the patient.”  CMS Publication 100-2, Chapter 7, §30.2.2, reiterates the use of ranges to ensure the most appropriate service to the patient.  

From those regulatory directives, we learn two important facts that will help agencies promote appropriate use of ranges.  
1. The frequency of visits can include a range.  The rules do not speak to a range in the duration.
2. Ranges ensure that the patient receives the most appropriate level of service.  In other words, ranges are for the patient’s benefit, not for the convenience of the staff.  Examples:  1) The therapist works two other jobs.  He often obtains orders for ranges to allow him flexibility in scheduling to meet all his commitments.  2) The nurse has unreliable childcare arrangements.  By ranging all patients, she doesn’t have to notify physicians about missed visits when she needs to tend to her children.

Remember these important points about using ranges:
• Ask staff to explain how the use of ranges for a particular patient ensures appropriate services.  
• Question wide variation in ranges, such as 1 to 4 visits a week.  
• Do not use ranges to accommodate variations in staffing schedules or compensate for staff shortages.  Example:  The nurse’s schedule does not permit her to see the patient four times this week but she’ll make up the visit next week.  The patient may not need an extra visit next week.  
• Do not use ranges to reduce the need to contact the physician or obtain verbal orders.  The Conditions of Participation require staff to contact the physician about changes that suggest a need to modify the plan of care.
• If you see frequent use of ranges, challenge the need.  Ask specifically how the range ensures proper care for these patients.  If the answer relates to a staff issue, such as reducing the need to send verbal orders, the range is not for the patient’s benefit and it is not appropriate.

A range is just one of the hundreds of topics addressed in the 2009 edition of the Beacon Guide to Medicare Service Delivery.  Check out this manual —  Coming next to this Web site, ranges and the HHABN.