NHIC Ask the Contractor Nov. 15

NHIC Corp., the regional Medicare Administrative Contractor, will host a Hospice & Home Health Ask the Contractor Teleconference (ACT) on November 15, 2012, at 10:00 a.m.  This Ask-the-Contractor Teleconference is an opportunity to speak directly with the contractor.  NHIC staff representing a variety of functions will be available to answer questions. NHIC usually will provide some updates to the home health and hospice community but the majority of this call is dedicated to providers as a question and answer open forum.

Registration is required on NHIC’s Education Programs webpage

Return to www.thinkhomecare.org.

Multimedia Home Care Ad Campiagn in Full Swing

The Home Care Alliance is engaged in its own campaign this fall.

The inaugural HCA Multimedia Campaign is in full swing this fall thanks to a partnership between the Alliance and WGBH where member home care agencies have the opportunity to “sponsor”  public radio programming. These sponsorships are mentioned on 89.7 WGBH (Boston Public Radio) as well as 99.5 Classical New England and direct listeners to a custom webpage with the participating member agencies.

Also rotating with other sponsors on the WGBH and Classical New England websites is a graphic that also directs people to the HCA’s custom webpage.

The sponsorships play continuously through the first week of November for participating member agencies and run on various times through the day.

These sponsorships promote the home health or home care agency, but also raise the profile of home care and generate interest in the industry at large. The listeners of these stations are overwhelmingly the demographic of people that are interested in learning more about or obtaining home care.

To hear a couple of the sample sponsorships, see the audio clips below:

Guest Post: Utilization of Post-Acute Services by ALF Residents

The following is a guest blog post on the utilization of post-acute services by residents of an assisted living facility written by Elizabeth Hogue, Esq. The author plans future articles on this subject so be sure to check back for updates!

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents to “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.

How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?  The most effective way to maximize utilization of these services may be to take a multi-pronged approach that includes:

1. Assignment of liaisons/coordinators from post-acute providers to ALF’s

Use of coordinators/liaisons at ALF’s raises issues related to violation of the federal anti-kickback statute.  This statute generally prohibits providers from either offering to give or actually giving anything to referral sources in order to induce referrals.  Consequently, liaisons and coordinators must be scrupulous about avoiding the provision of free services to ALF’s and/or their residents.  Possible violations include “staffing” an office with an RN who responds to requests from residents in their apartments or has “office hours” to address health conditions of residents.

Continue reading “Guest Post: Utilization of Post-Acute Services by ALF Residents”

New OASIS Guidance from CMS

CMS has just released the latest guidance for OASIS, October 2012 Quarterly Q&As.  This quarterly update contains 11 new Q&As including the latest CMS OASIS-C guidance with a special item about selecting fall risk assessment tools based on standardization, validation and multi-factor requirements.Other highlighted items:

  • situations where the physician-ordered ROC date is outside the assessment time frame
  • selecting a response for patient confusion when confusion level varies
  • how/when bipolar disease and other psychiatric diagnoses might impact the depression process measure.

ODF-Medical Review of Therapy Claims

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum on the Manual Medical Review of Therapy Claims on October 22, 2012 from 2:00pm-3:30 pm.

The review of therapy claims applies to all Part B outpatient therapy settings and providers including home health agencies that bill Part-B outpatient (TOB 34X). The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for providers to ask questions about the mandated manual medical review of therapy services from October 1-December 31, 2012 that was enacted by the Middle Class Tax Relief and Job Creation Act of 2012.

During this Special Open Door Forum, CMS will discuss therapy documentation requirements and answer any questions providers may have. Participants may submit questions prior to the Special ODF.

To participate in the call, dial: 1-866-501-5502; Conference ID: 44803009.

Return to www.thinkhomecare.org.

OIG Releases 2013 Work Plan for Home Health

The HHS Office of Inspector General (OIG) Work Plan for Fiscal Year 2013 was recently release and provides brief descriptions of activities that OIG plans to initiate or continue in fiscal year 2013.

The Work Plan describes the primary objectives and provides for each review its internal identification code, the year in which we expect one or more reports to be issued as a result of the review, and indicates whether the work was in progress at the start of the fiscal year or will be a new start during the year.

The OIG’s Work Plan for home health addresses seven areas for review:

  • Home Health Face-to-Face Requirement (New)
  • Employment of Home Health Aides With Criminal Convictions (New)
  • States’ Survey and Certification: Timeliness, Outcomes, Follow-up, and Medicare Oversight
  • Missing or Incorrect Patient Outcome and Assessment Data
  • Medicare Administrative Contractors’ Oversight of Claims
  • Home Health Prospective Payment System Requirements
  • Trends in Revenues and Expenses

Return to www.thinkhomecare.org.

NHIC’s Review of Home Health Claims with 5-7 Visits

The NHIC, Corp. Medical Review Department has recently completed a review of home health claims with five-seven visits billed. Of the 80 claims review, 28 were paid as billed. The remaining 52 claims had some denials resulting in a claim denial rate of 65%. The total charges reviewed included $72,694.98 of which $32,749.95 was denied. This resulted in a charge error rate of 45%.

The majority of the claims were denied because the skilled nursing services were not supported as being medically necessary in the medical records. Read more in the educational article Review of Home Health Claims with 5-7 Visits

Return to www.thinkhomecare.org.