Home Health & Hospice Week

7 steps for using this essential benchmark to avoid throwing thousands of dollars down the drain.

Many home health agencies are claiming more SCICs than they should, and losing big bucks as a result--are you?

First, HHAs must determine if a significant change in condition has occurred clinically. Then, the agency can calculate whether claiming the SCIC is fi-nancially beneficial--if it's not, the HHA usually does not have to claim it. 

Warning: Agencies often claim the SCIC even when it loses them money, experts warn. That's either because they don't know how to calculate the SCIC payment properly or don't realize they don't have to claim a money-losing SCIC except in rare cases.

The stakes: And billing unnecessary SCICs can be a costly affair, warns consultant M. Aaron Little with BKD in Springfield, MO. One BKD client lost about $80,000 by doing so, only recovering the money with the consultants' help.

Cost report data analysis shows an average SCIC-adjusted episode pays about $300 to $600 less than a non-SCIC-adjusted episode, Little says. And the cost for an unnecessary SCIC can rise to as much as $3,000 per episode, he warns.

Little offers these tips to help you figure out if you're losing money on unnecessary SCICs: • Compute your SCIC stats. Two figures are important when benchmarking yourself against SCIC norms, Little tells Eli: (1) your total percent of billed SCICs and (2) your average SCIC episode payment versus your average episode payment overall. The average episode payment overall should include all episodes, including SCICs, PEPs, etc.

HHAs can compute these figures from their costs reports, Little notes. Or some agencies' software systems may offer them more up-to-date SCIC data. • Compare your stats to benchmarks. Al-though it's not surefire, you can be pretty certain you're claiming too many SCICs--and throwing away hard-earned dollars--if your percent of billed SCICs is higher than the norm, Little advises. He puts the average SCIC amount at 2 to 3 percent.

Likewise, you can compare your average SCIC episode payment to your average episode payment overall. If your SCIC episode payment is lower, you're probably losing money by claiming unnecessary SCICs, Little warns.

"The intent of the SCIC adjustment is to allow additional payment when a patient's condition declines," Little urges. "The typical SCIC-adjusted episode should pay more on average than the other episodes." That's true despite the rare cases where the agency has to claim an unfavorable SCIC when a patient's condition unexpectedly improves, he adds.

More information: HHAs that want a more specific SCIC figure to compare with can look to benchmarking reports, such as the one offered by Eli Research and BKD, for specific benchmark figures for the nation, their provider type, their local area, and other specific pools. • [...]