Home Health & Hospice Week

Do you know the ropes for billing daily skilled nursing visits?

You'd better pinpoint your endpoint problems now before medical reviewers do it for you--and deny your claims.

Medical reviewers frequently deny claims because home health agencies fail to include an endpoint statement for daily skilled nursing care, regional home health intermediary Palmetto GBA notes in its "Medical Review Topic of the Month" for January.

Medicare regulations require the home care benefit to be intermittent, Palmetto notes in the article. That means daily skilled nursing visits for more than 21 days disqualify a patient from the benefit, unless the record includes a statement of a "finite and predictable" endpoint for the daily nursing care.

Other exceptions: Daily nursing visits are also OK (1) if therapy is also furnishing services at the same time or (2) if there are orders for the nurse to administer daily insulin injections and documentation of why the beneficiary can't or won't inject.

Crafting a valid endpoint statement can be tricky. The statement should specifically address nursing visits and should offer a timeframe for when they will cease being daily. You can state the timeframe in number of weeks or months, or just use a specific date, the RHHI advises.

Pitfall: Using general phrases like "wound care will decrease to less than daily in three months" or "daily visits to decrease when wound heals" won't cut it, Palmetto warns. You must include nursing visits spe-cifically and predict a finite and predictable endpoint.

Resource: For more endpoint dos and don'ts, see Palmetto's article at www.palmetto.gba --click on "RHHI", "What's New" and scroll down to the endpoint article. Or email editor Rebecca Johnson at rebeccaj@eliresearch.com with "Palmetto Endpoint Article" in the subject line to receive a free copy of the article. • If you think your Medicare provider number will stay intact even if you don't serve Medicare patients for a while, think again. In a Dec. 31 opinion, an administrative law judge ruled that the Centers for Medicare & Medicaid Services could terminate the provider agreement of United Medical Home Care Inc. of Panorama City, CA, which hadn't served a Medicare patient in six months.

Gray area: CMS has the discretion to decide what timeframe is too long to go without serving Medicare patients for enrollment purposes, says the decision from ALJ Keith Sickendick.

"We remain concerned about agencies that put their provider agreement 'on the shelf' and later resume operations, or try to sell their 'agency,'" NAHC warns in a message to members. Such agencies could see terminations, enrollment problems or revoked billing privileges. Rather than ceasing operations, HHAs would be safer to continue limited operations, even to just a few Medicare patients, NAHC counsels. • Connecticut should put more resources into home [...]