Home Health & Hospice Week

Medicare paid approximately $1.8 billion in 2006 in hospice claims for beneficiaries in nursing facilities that didn't meet at least one Medicare condition of requirement.

That's the news from a recent Office of the Inspector General report that also found that 33 percent of nursing facilities' hospice claims didn't meet election requirements, and a whopping 63 percent didn't meet plan of care requirements. Another 4 percent didn't meet certification of terminal illness requirements.

In a companion piece, the OIG examined the hospice services provided to the beneficiaries in nursing facilities and found that Medicare paid $2.59 billion at an average of $960 per week per beneficiary. Hospices provided nursing services on 96 percent of claims, home health aide services for 73 percent of claims, and medical social services for 68 percent of claims, the report found. Drugs were provided in 96 percent of claims.

Recommendations: Based on the high percentage of noncompliance and spending, the OIG suggests that the Centers for Medicare & Medicaid Services educate hospices about coverage requirements and how to ensure quality of care, provide tools and guidance to help hospices meet the coverage requirements, and strengthen the use of targeted medical reviews and other oversight methods to eliminate waste and noncompliance.

CMS responded that it has put most of those measures in place over the past few years, but it does plan to share the OIG's findings with its contractors so that they better prioritize medical review strategies and other interventions.

The OIG hopes its companion report will help CMS "determine whether the types and frequencies of hospice services provided to beneficiaries in nursing facilities meet the goals of the hospice benefit and whether current payment rates are aligned with the hospice services being provided."

These studies were based on data from a medical record review of random samples of 450 hospice claims, of which 43 percent were from nonprofits, 53 percent were from for-profits, and 4 percent were from government hospices.

Resource: Read the report at www.oig.hhs.gov/oei/reports/oei-02-06-00221.pdf and the companion piece at www.oig.hhs.gov/oei/reports/oei-02-06-00223.pdf.

• Home care professionals have another

tool at their disposal to help stroke survivors cope with post-stroke depression. The nurse-led behavioral intervention program called "Living Well with Stroke" (LWWS) provides individualized counseling sessions using social interactions and physical activity as a way to elevate mood.

Researchers conducted a clinical trial involving more than 100 stroke survivors who exhibited symptoms of post-stroke depression and compared LWWS against usual post-stroke care.

The study included participants from 25 to 88 years old, with more than 70 percent having experienced at least one episode of depression prior to their stroke, while 60 percent were taking an antidepressant medication at entry into the study. Depression scores in the LWWS group were significantly lower after treatment and at one-year follow-up. At two years, depression scores continued to decrease and remission rates continued to increase, according to the study, funded by the National Institute of Nursing Research.

with a free online course from intermediary Cahaba GBA at www.cahabagba.com/rhhi/education ; select"Online Courses."

New codes take effect Oct. 1 for episodes with date of service on or after that dates. New and deleted codes are at www.cms.hhs.gov/Transmittals/downloads/R1770CP.pdf.

• Growing older doesn't mean you have to deal with falling down, but your patients may not realize that.

"Too many people erroneously consider falls a normal consequence of growing old, but it's simply not true," said Judith Daniel, PT, with the American Physical Therapy Association. Along with properly assessing fall risks, home care workers should educate their patients about what they can do to avoid falls.

Examples: APTA suggests that you encourage patients to have their eyes checked by a doctor at least once each year. You should also work with them to reduce hazards and improve the lighting in their homes.

Patients who use walking aids are also at risk for falls, the association noted. Give patients this advice to keep them safe and upright when using a walking aid:

• Make sure the patient's walking aid is no taller than the height of his or her wrists when his/her arms are at his/her sides.

• Your arms should be slightly bent when holding onto a walker, but you shouldn't need to bend forward at the waist to reach it.

• Replace rubber tips at the bottom of your walking aid when they are uneven or worn through.

• Cahaba GBA wants agencies to submit their flu shot claims to Medicare electronically using the roster bill screen available in the Fiscal Intermediary Standard System, according to its recent newsletter.

You'll receive reimbursement for administering flu shots under the Outpatient Prospective Payment System (OPPS) Ambulatory Payment Classification (APC) code 0350 that's assigned to HCPCS code G0008, the intermediary noted. The same goes for H1N1 vaccine administration for HCPCS G9141.

Remember: Your reimbursement amount is adjusted for the geographic area where the shot was provided. So while the reimbursement for APC code 0350 is $24.89, the actual payment you receive could be more or less than that amount, Cahaba said.

• Patients who are hospitalized for acute coronary syndrome (ACS) and who have major depression are twice as likely to die during the next seven years if their depression doesn't significantly improve, according to a study published in the Archives of General Psychiatry.

Your job: Patients whose depression gets better within the first six months had half the death rate over the next seven years of those whose did not. As you begin screening for depression under OASIS C, focus on follow-up for those patients who do show signs of depression.