Home Health & Hospice Week

Clinician-billing communication will be key to securing your rightful reimbursement.

You'll have a complicated new OASIS item to answer when prospective payment system refinements hit in January--but you can take steps to make sure you ace the reimbursement question.

Brand new OASIS item M0110 asks about a patient's previous home health episodes. Under PPS revisions, Medicare will pay more for third or later "adjacent" episodes, no matter who provides them.

To get your rightful reimbursement from the start, experts advise you to start planning now to utilize the following advice:

1. Bill timely. Using the Common Working File (CWF) to determine patients' prior episodes won't work unless the previous agency submits requests for anticipated payment (RAPs) and final claims promptly, notes consultant M. Aaron Little with BKD in Springfield, MO.

And make sure you are billing for all episodes. "While this is obviously important at all times, M0110 heightens the priority for all providers," Little tells Eli.

2. Check the CWF. An agency's first step in determining the correct answer for M0110 should be to check the CWF, advises William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law.

Agencies are lucky, because determining prior home health stays in the CWF is much more clear than figuring out prior inpatient stays as required for the current M0175 case mix item, Little notes.

3. Ask the beneficiary. Patients are not always the most reliable source of information for prior service history, experts admit. Nevertheless, patients can offer important clues as to prior home health episodes, so ask them about M0110, Dombi counsels.

4. Ask the attending physician. Likewise, attending physicians aren't a definitive information source but often may have information that helps you answer M0110 accurately. Check with him or her about prior history, Dombi suggests.

5. Share information. Information on a prior home health episode that gets lost in the shuffle won't do anyone any good. "Ensure communication procedures are clear between clerical/billing staff and clinical staff," Little urges.

Do this: Office staff and billers should share the CWF information with the clinician prior to finalizing the OASIS assessment, Little stresses. The same goes for any clues unearthed from patients or referring physicians, which may require further digging.