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Breathe A Little Easier On These Expedited Review Notice Topics

Published on Mon May 23, 2005

Hint: You can deliver the notice at the start of care if you want to.

The expedited review notice may be a crushing new burden on you, but there are a few bright spots in new information on the requirement.

Good news: The Centers for Medicare & Medicaid Services appears to be treading lightly in the enforcement area for the requirement set to hit this week.

"CMS is well aware this review process is new to both beneficiaries and providers, and not much advance notice could be given to either because of the regulatory processes for finalizing both the regulation and notices," the agency says in its June 3 transmittal to intermediaries. "While all parties, including CMS, must make every attempt to meet these requirements, CMS realizes there will be many questions and possibly some missteps at the beginning."

Bottom line: "CMS will not seek to take punitive action in such cases as all involved parties become accustomed to the process," it says in the transmittal.

Don't dally: Of course, when that trial period ends is unclear, so smart providers will get their compliance ducks in a row as fast as they can.

HHAs shouldn't get "worked up" over the new requirement if they can't get all the details nailed down immediately, advises Burtonsville, MD-based attorney Elizabeth Hogue. As long as you thoroughly document a good faith effort to comply with the requirement, Hogue believes you'll be in the clear.

Here's a rundown of some other breaks providers received in the recent, voluminous guidance on the new notices: 

  • When to issue. Possibly the most transforming clarification is that agencies can issue the expedited review notices any time up to the second-to-last visit - including at the start of care. Nothing in the regulation precludes agencies from issuing the generic and detailed notices at the outset, CMS admitted in the June 20 special Open Door Forum on the topic.

    Furnishing the generic notice up-front may be a practical strategy agencies want to adopt, suggests Gene Tischer with Associated Home Health Industries of Florida. "You can just make it part of your sign-up packet" if you can predict the discharge date accurately, Tischer notes.

    Even if the discharge date changes, you can issue an amended notice when the change occurs instead of waiting until the last moment, Hogue points out.

    Caveat: Regardless of when you issue the notice, beneficiaries can elect expedited review up to the day before discharge, CMS says.

    Although this conduct would be in compliance, CMS indicated in the forum that it may frown on early notices. "The notice may be provided earlier than two days in advance, but should not be given so much in advance that the beneficiary fails to understand it is linked to discharge," CMS adds in the transmittal.

    Home care providers may not want to furnish the detailed notice at the outset because they won't usually have to issue that notice anyway, CMS suggested in the forum. Beneficiaries receive the detailed notice only when they initiate expedited review of the termination or otherwise ask for it, CMS notes.
     
  • Phone delivery. Home care providers sometimes can deliver the notice over the phone and follow up with a mailed copy rather than making an extra visit, CMS says. "In non-residential settings where beneficiaries are not at hand ... the process did not envision tasking providers with trips just to provide notice, since there is no reimbursement for notification," the agency says in the transmittal. "While in person notification should be done whenever possible ... it is not required to be in person if involving unavoidable additional costs."

    CMS says providers should be prepared to hand deliver notices during their usual course of visits, but exceptions include when the physician terminates home care unexpectedly or when the visiting clinician finds the forms illegible when she gets to the patient's residence.

    Home care providers, however, must be sure to secure a signed copy of the generic notice for mail delivery, CMS said in the forum. HHAs may have to pester beneficiaries for the signed form, Hogue predicts.
     
  • Exceptions. Providers must issue the new first-step, generic notice to every beneficiary whose Medicare-covered services end, CMS instructs. But there are some exceptions to the rule, including when the beneficiary goes into the hospital; when the beneficiary dies; when services end for reasons other than coverage ending - such as staffing or safety concerns; when the patient is discharged because she is in the hospital on the 60th day of the episode but she will be starting another episode when she returns home; and when the agency can't locate the patient. You should document these special circumstances, experts advise.

    CMS may offer further exceptions in upcoming Q&As, officials said in the forum.
     
  • Business hours. CMS will let up on the regulatory timeframe requirements when things happen outside of a provider's normal business hours, it says in the transmittal. "Not all providers maintain 24-hour a day operations, and the expedited determination regulation was not intended to require new hours of operation."

    For example, if a Quality Improvement Organization notifies an HHA of a review shortly before the agency's usual close of business, the provider is off the hook for furnishing the detailed notice and medical records that same day. But "the beneficiary still must be notified as soon as possible once business recommences, and it is recommended medical records be documented noting the limitation caused by routine hours of operation," CMS says.
     
  • Delegation. HHAs can delegate delivery of the notices to an agent who agrees, in writing, to adhere to all the delivery requirements, CMS says in the Q&A.
     
  • Medical review. Providers shouldn't get caught between the QIOs and regional home health intermediaries under the new system, CMS promises. RHHIs aren't supposed to medically review care that already has been approved by a QIO.

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