Home Health & Hospice

Transmittal Forbids Discharge/Readmit for Hospitalization

Homecare Insider, June 28, 2010

Agencies have questions about how to handle a patient’s hospitalization.
Can we still discharge patients who are hospitalized?  We have discharged patients who were hospitalized for 72 hours or more but I recently heard that we shouldn’t do this.  My administrator thinks we should continue this policy.  Patients hospitalized that long usually require more resources upon their return home.  We could start over with a new start of care assessment. 

A new policy directs the actions an agency must take.  The final rule for the Prospective Payment System (PPS) in 2000 said that the PPS would not recognize for payment purposes the discharge of a patient who was hospitalized.  The agency was free to discharge whomever whenever but when it came to payment, that discharge would not hold.  However, this instruction was never incorporated into a manual and agencies have been discharging and readmitting patients within the same 60-day episode.  If a patient needed more resources upon resumption of care, the agency could take advantage of a new Health Insurance Prospective Payment System (HIPPS) code with more revenue attached.

However, effective July 1, 2010, an agency will no longer be able to do that.  New text in the Medicare Claims Processing Manual, CMS Publication 100-4, Chapter 10, reads, “A beneficiary does not have to be discharged from home care because of an inpatient admission.  If an agency chooses not to discharge and the patient returns to the agency in the same 60-day period, the same episode continues.  However, if an agency chooses to discharge, based on an expectation that the beneficiary will not return, the agency should recognize that if the beneficiary does return to them in the same 60-day period, the discharge is not recognized for Medicare payment purposes.  All the home health services provided in the complete 60-day episode, both before and after the inpatient stay, should be billed on one claim.”

An agency will no longer be able to discharge and readmit a patient who is hospitalized if the hospitalization and return home are within the same 60-day episode.  If a patient resumes services prior to the 60th day of the episode, the agency must resume services under the same HIPPS code established by the start of care assessment – no matter the circumstances.  If the patient does not resume services by the end of the 60th day, the agency can discharge him or her and start a new episode upon return home. 

Download Transmittal 1904 at — http://www.cms.hhs.gov/transmittals/downloads/R1904CP.pdf.  Also dial in for the audio conference on July 15 that will discuss this and other PPS changes in more detail.  Click on — http://www.beaconhealth.org/cgi-bin/ccp51/cp-app.cgi?pg=prod&ref=J071510A — for more information.