Home Health & Hospice Week

The catch: Visit must occur after referral.

You may want to reconsider your admissions process, based on a recent HHS Office of Inspector General advisory opinion. Last month, the OIG gave its stamp of approval to a home health agency furnishing nonmedical “introductory visits.”

The scenario: As laid out in the HHA’s letter requesting OIG approval, a hospital discharge planner contacts the agency only after a patient has selected the agency as its home health provider. The agency “has no involvement in the patient’s selection process” and “does not offer or pay, either directly or indirectly, overtly or covertly, any remuneration to the physicians, health care professionals, or other individuals or entities that are referral sources involved in the patient’s selection process,” it certifies in its letter.

After the referral, the agency contacts the patient by phone to see whether she wants an introductory visit by an agency-employed “liaison” either in person, by email, or by phone. “The primary purpose of the Introductory Visit is to facilitate the patient’s transition to home health services in an effort to increase compliance with the post-acute treatment plan,” the OIG recounts in Advisory Opinion No. 15-12. “To that end, during the Introductory Visit the Liaison: (1) provides an overview of the home health experience; (2) gives the patient written materials that list the contact information for some of the Requestor’s administrative and clinical employees; and (3) shares pictures of members of the Requestor’s care team who will furnish the home health services.”

Very important: The liaison, who is an LPN, doesn’t provide “any type of diagnostic or therapeutic service reimbursed by Federal health care programs during the Introductory Visit, and does not leave any other items or materials with the patient,” the OIG spells out.

Also important: “The Liaison does not contact the patient prior to receiving notification from the physician or health care professional that the patient has selected the [agency] as his or her home health provider,” the OIG notes.

No Skilled Services = No Remuneration

The decision: “The Introductory Visits do not provide any actual or expected economic benefit to patients, and therefore do not constitute remuneration,” the OIG concludes in the opinion. No remuneration means no violation of anti-kickback or Civil Money Penalty laws.

Why? The visits include “only information about the [agency’s] employees … and an overview of the home health experience,” the OIG notes. “The primary purpose of these activities is to facilitate patients’ transitions to home health services in an effort to increase compliance with their post-acute treatment plans.”

Perhaps most importantly, “the Liaison does not provide any federally reimbursable diagnostic or therapeutic services during the Introductory Visits,” the OIG points out.

Key #1: This opinion hinges on the fact that the visit is made after the referral, stresses attorney Robert Markette Jr. with Hall Render in Indianapolis. “You can’t influence a patient’s decision if the choice is already made,” Markette points out.

Key #2: It also depends on the fact that no skilled services are furnished during that visit, notes Washington, D.C.-based health care attorney Elizabeth Hogue.

Talk Hospitals Into The Plan

You can run a cost-benefit analysis to determine whether instituting similar introductory visits would benefit you, Markette suggests.

But if you decide to pursue them, you may run into an obstacle: the referring hospital not allowing you access to the patient. “Some hospitals have been reluctant to permit home health agencies and other post-acute providers to make visits to patients prior to discharge,” Hogue cautions.

You can use this opinion to help sway them. Emphasize that you would furnish such visits only after receiving a referral, therefore not wandering into forbidden marketing territory, Markette counsels.

In the opinion, the OIG not only gives permission for such visits — it “clarifies that such visits are important to effective care transitions,” Hogue stresses.

Focus on how such visits will improve patients’ transition to home and compliance with post-acute care plans, Markette offers. That, in turn, will result in better outcomes for the patients — and fewer rehospitalizations that drag down hospitals’ bottom line under Medicare reimbursement.

Note: See the opinion at http://oig.hhs.gov/fraud/docs/advisoryopinions/2015/AdvOpn15-12.pdf.