Home Health & Hospice Week

Tip:  Consider your wording carefully to stay in compliance.

The feds won't let you use ranges in the new home health advance beneficiary notices (HHABN)--but there is a way to reduce paperwork and stay in compliance.

In recent weeks, the National Association for Home Care & Hospice has been working with the Centers for Medicare & Medicaid Services to clarify this question: How can agencies translate range of visit information found in care plans into meaningful information for use on the HHABNs--and stay in compliance.

Hot issue: The question is an important one for home health agencies because a high percentage of plans of care include orders for ranges of visit.

"Our guess is that 60 to 70 percent of plans of care do include ranges," reports Mary St. Pierre of NAHC.

Clarify Matters For Beneficiaries

Confusion about visit ranges intensified recently when CMS released instructions for the Medicare fee-for-service home health advance beneficiary notice that prohibits the use of ranges, reports NAHC (See Eli's HCW, Vol. XV, No. 34).

The disconnect between care plans and HHABNs continues to challenge agencies, reports Robert Markette, an attorney with Gilliland Markette & Milligan in Indianapolis, IN.

If CMS retreats from its prohibition of ranges on the HHABNs, home health agencies will be able to state ranges simply, as they do on care plans, explains St. Pierre. But if the prohibition stands, agencies must proceed with caution.

Best bet: To stay in compliance--and keep beneficiaries clear on what to expect--specify on the HHABN that the lowest number of visits in the range will be provided, with additional visits if the patient's condition warrants, advises NAHC.

Word it right: But agency staff should be careful about how they word such statements, stresses St. Pierre. If a patient is being seen for teaching and a physician orders nursing visits of one to two times per week, the HHABN should state that "nursing visits will be provided one time per week, with an additional visit if additional teaching is needed."

Background: CMS has been clear that ranges are okay on care plans. A 1992 letter from CMS sent in response to an NAHC inquiry, for example, explained that additional physician orders are not required to change visit frequency within an ordered range of visits noted on the care plan. "The purpose of a physician ordering a range in the frequency of visits to the patient for each service is to ensure that the most appropriate level of service is provided to the patient by home health agencies," CMS stated, referring to care plans.

CMS confirmed its earlier advice about the use of ranges on care plans in a 2005 e-mail message, NAHC reports. "If it is not possible to identify the specific frequency of visits, it is acceptable to use a range of visits to ensure that the most appropriate level of service is provided to the patient and the visit frequency continues to meet the identified needs of the patient," the e-mail states.

CMS offered this example to illustrate: "Where the physician orders a range of visits from 1-3 times a week, the HHA can provide either one, two or three visits to the patient during any given week and still be in compliance with the plan of care, as long as the frequency provided meets and continues to meet the patient's needs. There should be evidence in the clinical record to support the visit frequency."

Goal: NAHC's aim is to convince CMS that home health agencies should be able to use ranges on the HHABNs in the same manner as allowed on the plan of care.

"We believe that it would much less confusing to beneficiaries to receive one form with a range than a new form every week," St, Pierre explains.

Unfortunately, agencies may have a long wait for clarification from CMS. No updates are immediately forthcoming, reports St. Pierre.

Note: The regulations for completing the plan of care are found at 42 CFR 484.18. To review the regulations, go to www.access.gpo.gov/nara/cfr/waisidx_04/42cfr484_04.html.