Home Health & Hospice Week

Beware: The anti-kickback law isn’t the only thing to worry about.

Furnishing introductory visits as allowed by the OIG may seem like a great idea, but you need to sidestep common pitfalls that could result in fraud charges.

Consider these tips when implementing your introductory visit program:

1. Keep it strictly post-referral. The HHS Office of Inspector General repeatedly emphasizes that for an introductory visit to be compliant with anti-kickback and CMP laws, it must occur after a patient already has chosen a home health agency as its provider (see story, p. 250). “The Introductory Visits provided under the Arrangement are distinguishable from other potentially problematic arrangements because patients already have selected the [agency] as their home health provider when the Liaison contacts them, and the Introductory Visits are a logical and reasonable first step in the care relationships that have been established,” the HHS Office of Inspector General pronounces in Advisory Opinion No. 15-12.

 “There should be no contact until after the patient has already chosen you,” stresses attorney Robert Markette Jr. with Hall Render in Indianapolis.

2. Ban medical services. The OIG also reiterates that its approval depends on the fact that the services furnished have no more than “intrinsic” value, so they can’t trigger kickback or CMP violations. “Insofar as the Introductory Visits have only some intrinsic value to patients and involve the simple provision of information, they differ from other visits or assessments by health care providers that may constitute remuneration because they are reimbursable or provide services of more than nominal value to patients,” the watchdog agency explains. “The key is clearly to make certain that no skilled services are rendered to the patient,” advisesWashington, D.C.-based health care attorney Elizabeth Hogue.

3. Choose liaisons carefully. If you send a nurse to do your introductory visits, you’re asking for inadvertent violations, Markette warns. That’s because the nurse may be tempted to furnish medical services, especially if the hospital staff there ask her to “help out” with something.

The best way to make sure no skilled services are rendered during the visit “is to send unlicensed staff, such as unlicensed coordinators or liaisons,” Hogue counsels.

Likewise, sending a marketer is a risky proposition, Markette suggests. They may be tempted to talk to patients who have not yet selected you as their home care provider, which would violate the OIG-approved agreement outlined in the opinion.

4. Avoid HIPAA risk. Once your liaison is in the hospital, staff there may ask them to talk to patients about home care. Besides avoiding this practice for kickback concerns, your employees should also beware falling into a HIPAA trap, Markette cautions. If you’re not a Covered Entity or Business Associate who needs the information for treatment, payment or health care operations, you don’t have authorization to access patients’ PHI under the law.

“Well-meaning staff may overreach,” Markette tells Eli. “They can only talk to patients after a referral.”

5. Prioritize staff education. Following the rules for introductory visits may be counterintuitive for staff who want to help potential clients or hospital colleagues. Be sure to train — and retrain — staff to avoid violations. “Be clear that your staff understands the boundaries,” Markette urges.

6. Eschew advertising. The OIG doesn’t mention advertising these introductory visits in this opinion, Markette acknowledges. But in opinions for similar practices, the watchdog agency often clarifies that such services not be advertised by the providers offering them. Following suit is a smart move for compliance, Markette suggests.

7. Consider your content. Don’t feel you have to limit your introductory visit activities to those specified in this opinion, Hogue suggests. The requesting agency said it offers a home health overview and staff information (see story, p. 250).

“Although the Advisory Opinion describes the services that the requestor wants to provide, I don’t think providers should interpret this list as limiting them to those activities,” Hogue says. “Other non-skilled activities seem to be allowed, too.”

The description of visit content in the opinion is not very detailed, Markette notes. It makes sense that more information (that still complies with the guidelines) would be permissible.