Home Health & Hospice Week

Daily care with no realistic endpoint will sink your claims.

Get ready to defend your claims for patients receiving daily nursing care.

Regional home health intermediary Cahaba GBA has targeted claims with 55 nursing visits, a length of stay greater than 60 days and no therapies, the RHHI says in its May newsletter to providers.

The culprit: In a probe review of 72 such claims from August through February, Cahaba reviewers denied 69 percent. Home health agencies' main problem was not meeting the intermittent skilled nursing requirement.

"Intermittent skilled nursing care is a medically predicable, recurring need that is provided fewer than seven days each week or fewer than eight hours each day, for periods of 21 days or less," Cahaba explains in its May Newsline. "In exceptional circumstances, daily skilled nursing care may be covered as long as a finite, predictable, and reasonable endpoint is documented."

Do this: Repeatedly ordering daily care for 21 days doesn't meet the intermittent requirement, the RHHI maintains. The agency "must forward medical documentation justifying the need for such additional services and include an estimate of how much longer daily skilled services will be required," Cahaba instructs. "This should occur before the end of the initial three weeks of daily skilled nursing care."

Providers may have to accept that their patients aren't eligible for the Medicare home health benefit. "A beneficiary who is expected to need more or less full-time skilled nursing care over an extended period of time would not usually qualify for home health care," Cahaba says.

Exception: Daily visits are covered for diabetic patients who need daily insulin injections and don't have a caregiver to give them, Cahaba adds.

The review notice is at www.cahabagba.com/rhhi/news/newsletter/200805_rhhi.pdf. • This year's Medicare legislative package continues to take shape in Congress. The Senate Finance Committee is considering legislation that would delay physicians' 10 percent Medicare payment rate cut for 18 months at a cost of up to $18 billion over five years, according to press reports.

Negotiations over where the Medicare funds will come from leaves home care providers vulnerable to payment cuts, industry observers warn.

The Centers for Medicare & Medicaid Services has informed Congress that it would require a June 16 passage date to make sure physician cuts don't take effect on July 1. However, Congress could always revise the cut retroactively. • More states are waking up to the benefits of funding home care. The latest example is Connecticut, which has a bill pending in the state legislature that would help 5,000 elderly and disabled people move from nursing homes to their own homes and community-based housing, reports the Associated Press.

The state Senate has approved the measure and it now heads to the state House, AP says. • The new [...]