Home Health & Hospice Week

But agencies can breathe easier on other coding-focused probes.

If you're using trauma diagnosis codes for your home health patients, you'd better double-check you're doing it right.

Trauma codes continue to be among the top-denied diagnosis codes for home health agencies, according to regional home health intermediary Cahaba GBA. Medical reviewers tend to find trauma codes inappropriate either because the wound was a trauma but not the focus of skilled care, or because the wound was not truly a trauma wound, the RHHI says in a posting on its Web site.

Codes in the 800 series must be due to injury or poisoning, Cahaba insists. "Surgeries and amputations performed for treating disease are not correctly coded from these trauma codes," the intermediary maintains. "Wounds that are the result of a disease process, such as diabetes, peripheral vascular disease, or pressure ulcers, are also not correctly coded from the trauma codes."

Cahaba's notice is at www.iamedicare.com/Provider/newsroom/whatsnew/20060130_trauma.htm. For more information on coding developments, see Eli's Home Health ICD-9 Alert at www.elihealthcare.com or by calling 1-800-874-9180.

• Meanwhile, Cahaba says it is staring widespread medical review for non-start-of-care claims with V58.61 (Long term use of anticoagulants- excluding aspirin) as primary diagnosis and no billed therapy visits. A probe review found errors in 60 percent of sampled claims.

Denials often occurred due to unnecessary skilled observation, Cahaba says. More information is at www.iamedicare.com/Provider/newsroom/whatsnew/20060126_probe1.htm.

• Fall prevention programs are the top strategy HHAs used to reduce patient rehospitalizations, according to the newly finalized Briggs National Quality Improvement/Hospitalization Reduction Study. The study, sponsored by Briggs Corp., Fazzi Associates and the National Association for Home Care & Hospice, identified 15 top best practices used by study participants.

More than 400 agencies with rehospitalization rates of 19 percent or lower participated in the study, according to NAHC. Other best practices include front-loading visits, providing 24-hour response and medication management.

The full report is available at no charge at www.nahc.org/NAHC/CaringComm/eNAHCReport/datacharts/hospredstudy.pdf. For more information, see Eli's OASIS Alert at www.elihealthcare.com or by calling 1-800-874-9180.

• Attention, Pennsylvania HHAs: If your patients who are dually eligible for Medicare and Medicaid got rolled on Jan. 1 into a full Medicare managed care plan, called a "Special Needs Plan," you can still get paid for services you're furnishing to them.

If you bill the SNP it "is required to pay you the Medicare fee-for-service (FFS) rate or billed charge, whichever is lower, for any Medicare-covered services provided during the period beginning January 1, 2006, and ending on March 31, 2006," Cahaba GBA notes in a posting on its Web site.

And your patients can disenroll from the SNP at any time and go back to FFS or another managed care plan, says the notice at www.iamedicare.com/Provider/newsroom/whatsnew/20060130_penn.htm.

• Part D insurers should not require durable medical equipment suppliers to provide a Part B rejection as a first step in the payment process, the Centers for Medicare & Medicaid Services advised listeners in a Jan. 24 CMS conference call on Part D versus Part B Drugs. Plans should have evidence justifying why they believe CMS should cover a particular drug in a particular situation under Part B before they require a rejection, CMS' Craig Miner said in the call.

For beneficiaries residing in their homes, Part B covers drugs that require administration via DME, such as inhalation drugs, IV drugs requiring a pump for infusion, and insulin via infusion pump. Part D covers these same drugs for residents of most long-term care facilities. More Part B versus Part D coverage information is at www.cms.hhs.gov/Pharmacy/.

• You need to give especially careful consideration to medication reconciliation if you are accredited by the Joint Commission on Accreditation of Healthcare Organizations. That's because Oakbrook Terrace, IL-based JCAHO has highlighted the National Patient Safety Goal in a recent Sentinel Event Alert.

"Medication reconciliation applies to all care settings--including ... home care," JCAHO warns in the Alert.  More information is at www.jcaho.org/about+us/news+letters/sentinel+event+alert/sea_35.htm.

• Arcadia Resources Inc. has acquired Remedy Therapeutics L.L.C. based in Crystal Lake, IL. Remedy Therapeutics, a respiratory services company, has annual sales of $2.7 million, the company says in a release. Southfield, MI-based Arcadia provides home care and staffing services, including travel nursing; mail-order pharmacy; and respiratory and durable medical equipment.

• VITAS Innovative Hospice Care has acquired Mercy Health Hospice in Darby, PA for undisclosed terms. Miami-based chain VITAS bought the hospice from Mercy Health System and will operate the program within its existing Philadelphia operation, VITAS says in a release. No layoffs are planned.