Home Health & Hospice

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Home Health & Hospice

Information, education, and guidance on complex topics such as Medicare compliance, agency management, coding and documentation, billing, aide training, and clinical management to help home health and hospice clinical staff, coders, staff educators, and administrators break down confusing regulations into easy-to-understand processes and procedures.

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  • Weekly Q&A: Can the OT make his or her initial assessment visit before the PT does if all staff make their visits on the same day?

    This is allowed, per Chapter 7, since eligibility has been confirmed. Now, if something happens and the qualifying service never had a chance to see the patient, there would be no payment. The following is from Chapter 7:

  • Inside Scoop: Who Can Complete Data Collection

    The ability to show the impact of care begins with an accurate assessment at the beginning of the episode. According to the Medicare Conditions of Participation (CoP 484.55), “A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status.” In cases that include nursing and therapy services, the registered nurse is required to complete the admission visit regardless of patient diagnosis or staffing availability. CoP 484.55 goes on to add, “When rehabilitation therapy service (speech language pathology, physical therapy, or occupational therapy) is the only service ordered by the physician, and if the need for that service establishes program eligibility, the initial assessment visit may be made by the appropriate rehabilitation skilled professional.”

  • Weekly Roundup

    In this week's roundup:

    • Home health class lawsuit denied. Collective action lawsuits have increased since federal overtime laws that affect home health care workers and their overtime have come into effect.
    • Public-private partnership of remote patient monitoring hints at patient satisfaction. Two years ago, the Visiting Nurse Association launched its remote patient monitoring (RPM) project, which targeted a congested heart failure population with extremely high hospital readmission rate.
    • Stakeholders: Home health 'PPS' spells 'pay cut' (again) for CY 2017. CMS' proposed changes for the Medicare Home Health Prospective Payment System (HH PPS) for Calendar Year (CY) 2017 include the expected—a reduction in payment—but nothing that will turn the home health benefit upside down.
    • Amedysis founder dies in floods. Amedisys Inc., one of the largest home health companies in the nation, has suffered greatly after the flooding in and near Baton Rouge, Louisiana: The company’s founder and former CEO, William “Bill” Borne, 58, die in the floods.

    Read full stories.

  • We use ranges on hospice patients. If we have a patient with ranges 1x-3x a month and the patient is only seen 1x that month, do missed visits need to be completed for the other two days the patient was not seen?

    You can use ranges on hospice patients. Missed visits are only needed if the agency does not meet the minimum of the range—so in this example, you would only notify the physician if the patient was not seen at least once in a month.

  • When we enter our discharge reason for home health, is it that the patient was transferred to an inpatient facility, or is the discharge reason that the patient expired?

    When our patients are admitted to an inpatient facility and we complete a transfer OASIS, we normally will choose not to discharge the patients and await their return home, resuming care at that time. We have a question about what happens if a patient dies while hospitalized and now needs to be discharged from home health. When we enter our discharge reason for home health, is it that the patient was transferred to an inpatient facility, or is the discharge reason that the patient expired?

  • Inside Story: Federal scrutiny for LOS and for-profit hospice facilities

    Editor’s note: The following is an excerpt from The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy.

    Federal and state regulators as well as private payers are working hard to curb the costs of Medicare and Medicaid programs. Although the vast majority of hospice providers are operation within the law, regulators have identified some bad actors. For example, a recent Office of Inspector General (OIG) study of hospice care in ALFs raised concerns about the possibility of hospices focusing on certain types of patients under the current payment system. The OI study concluded that hospices have financial incentives to serve patients in ALFs because these patients tend to have diagnoses associated with longer stays (such as ill-defined conditions, mental disorders, or Alzheimer’s disease) that often require less complex care and result in higher payments per patient for the provider.


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