Home Health & Hospice Week

Make sure OASIS backs up your patients' homebound status. Don't let your preoccupation with OASIS and coding result in slack homebound documentation, or you could be sorry -- very sorry. Lifeline Health Care Group Inc. is sorry to the tune of $1.17 million for documentation lapses the HHS Office of InspectorGeneral recently found, and the lion's share of those lapses were for patients'home-bound status (see "OIG Slaps $1.2M Overpayment On HHA For Documentation Lapses"). Homebound status was one of the OIG's favorite home care punching bags in its latest report to Congress as well, with nearly $1.7 million in settlements reached for documentation problems featuring homebound (see Eli's HCW, Vol. XIII, No. 22). HHAs "may see more and more denials due to homebound issues in the future," warns consultant Pam Warmack with Clinic Connections in Ruston, LA. Home health agencies that are distracted with OASIS and coding requirements sometimes lose sight of the importance of clear homebound documentation, worries clinical consultant Judy Adams with the Larson-Allen Health Care Group based in Charlotte, NC. These documentation lapses are part of a widespread trend, maintains clinical consultant Lynda Dilts-Benson with St. Petersburg, FL-based Reingruber& Co. Dilts-Benson "constantly" sees these types of documentation problems when she audits clients'charts, she says. To make sure you don't lose thousands to homebound reviews, try these experts' tips: 1. Document regularly. First off, "a strong statement describing the patient's homebound status must be documented at the time of admission," Warmack recommends. Then document homebound status with every single visit note from every discipline, Dilts-Benson urges. Avoid this common problem: Some agencies find that when they require homebound documentation at every visit, quality of the documentation decreases. To combat this problem, Adams advises clinicians to complete a very comprehensive and detailed explanation of what makes the patient homebound at every assessment and reassessment time point. 2. Cue documentation. Prompting clinicians on forms to document homebound status is a great way to solicit necessary support, counsels clinical consultant Karen Vance with BKD in Springfield, MO.

"On the forms that leave it up to the clinician to remember to document homebound status, it happens less," Vance observes. 3. Avoid generic terms. Bad documentation is sometimes worse than no documentation at all. "I've seen boxes with 'homebound status' checked, 'yes,'" Vance relates. "This is not convincing."

Notes should be patient-specific, Dilts-Benson advises. For example, they should include descriptions of specific equipment needs, barriers in the patient's home and assistance requirements, among other factors. Never: Simply listing "weakness" as the reason for homebound status isn't going to cut it, Adams contends. Records should include "clear statements of physical or mental functional limitations that demonstrate why the client has an inability to leave [...]