Home Health & Hospice Week

Don’t let indecision lead to noncompliance — and losses.

Home health agencies caught unprepared could be in for a reimbursement bloodbath when medical review of the physician’s estimated length of service hits.

Last fall, the Centers for Medicare & Medicaid Services finalized a requirement for physicians to estimate for how much longer patients will require skilled services. HHH Medicare Administrative Contractors have now started notifying providers of the requirement that took effect Jan. 1.

Don’t be surprised to see denials for this new requirement start very soon. “It will only be a matter of time until they begin to show up,” predicts Judy Adams with Adams Home Care Consulting in Asheville, N.C.

Consider following this advice to head off cash flow-crippling denials based on this new requirement:

1. Leave it to the physician. The language in the 2015 HH PPS final rule and the resulting CRs is very brief, but it now seems clear that the HHA will not be able to generate the estimated length of service for the physician to sign — the doc will have to furnish the estimate. CMS’s Randy Throndset agreed with that premise in the July 8 Open Door Forum for HHAs.

“Clearly, there has been communication that the HHA cannot make the determination,” Adams stresses. “It must be done by the physician.”

2. Communicate with the doc. Agencies should discuss the expected length of additional time needed for skilled services along with the HHA recommendations for continued services following the recertification assessment, Adams recommends. “This communication can be by telephone — but few doctors have the time for this type of phone call — or via a fax summary and recommendations,” she continues.

Caveat: “This would require the recertification assessments to be completed as early as possible in the 5-day window allowed for the [task],” she cautions.

3. Choose a method. At this time, it appears that agencies may be able to use two methods of obtaining the physician’s estimate — a separate physician statement or part of the recert verbal order. “Agencies will need to choose how they wish to document this information, as a verbal order or a physician statement, but the length of ongoing need for home health skilled care will definitely need to be on the plan of care or an addendum and signed and dated by the physician,” Adams stresses. 

Bottom line: Don’t let indecision lead to noncompliance.

4. Method: separate statement. The more surefire method is to get the physician to sign and date an explicit statement of the estimated length, either as a separate statement in the recert or as an addendum.

“Agencies could place a statement on the plan of care for the physician to complete, sign and date that indicates how much longer skilled services are anticipated,” Adams offers. “Something like: ‘Skilled services of (nursing, therapy) are expected to be needed for _________________________ (weeks/months)’ with a place for the physician’s signature.”

Don’t forget: If you go this route, “HHAs will need to send a note with the recertification plan of care asking the physician to complete the estimate and sign the statement,” Adams advises.

“I think the transmittal language is still a bit muddy” about this requirement, Adams cautions. She recommends erring “on the side of getting the physician to fill in the amount of additional time needed for skilled services until further clarification is announced.”

5. Method: verbal orders. If you treat the length estimate as part of the verbal order that establishes the recert plan of care, you should be able to include the estimate in the recert for the physician to sign. However, you must be sure the physician is the one who generated the estimate in the verbal order.

Don’t forget: To prove that occurred, you need to document that discussion and its date.

Then “my very strong suggestion is that a separate sentence be included in the summary stating that the MD was contacted and he verbally communicated the date he believes that services will end,” recommends Julianne Haydel of Haydel Consulting Services on her blog. “That may be overkill, but it isn’t a lot to do to protect your payment.”

You could also just send the estimate as an entirely separate verbal order and have the physician sign and date it, offers Lynda Laff with Laff Associates in Hilton Head Island, S.C. “This of course would be one more thing to track,” she observes.

6. Don’t rely on frequency and duration. MAC CGS has made clear that the frequency and duration of services listed in the recert will not satisfy the requirement for the estimated length of service.

7. Do it every time. The physician’s estimate of length of service is required for each recert, CGS confirms in its Q&As on the topic.

8. Reassure docs. Let your referring physicians know that the end date they select “is … not a law,” Haydel says. “If you go beyond it or discharge before, nobody will hurt you.”

9. Stay tuned. There is a potential for CMS to ease up on the particulars of the requirement. Keep an eye out for further communication from the feds.