Home Health & Hospice Week

Question: If you teach a patient with heart failure what to do when she develops signs of failure, she calls the physician as you instructed, and she sees her doc the next day, can you get credit for a physician contact in M1510 (response 1)?

Answer: No, says the Centers for Medicare & Medicaid Services in its latest response to OASIS C questions submitted by industry representatives.

The home health agency can mark response 3 (Implemented physician-ordered patient-specific established parameters for treatment) and response 4 (Patient education or other clinical interventions), CMS says in response to the question submitted by Fazzi Associates. But it can't mark response 1 for a few reasons, according to the Q&A posted on the National Association for Home Care & Hospice's Web site.

First, the patient contacted the physician herself, not agency personnel, CMS notes. Second, response 1 requires a same-day response from the physician and it's not clear if that occurred in the Q&A's scenario.

Resource: OASIS C Q&As, including more detail on this question, are available to everyone on NAHC's Web site at www.nahc.org/regulatory/home.html -- scroll down to the OASIS C category.

• You may have gotten used to treating patients with H1N1, but one habit you should drop is appending the "CR" modifier to related claims.

In 2005, CMS created the "DR" condition code (Disaster related) and "CR" modifier (Catastrophe/ disaster related) to facilitate the processing of claims affected by Hurricane Katrina, CMS notes in a release. Medicare contractors later allowed use of these codes for subsequent emergencies or disasters. However, on July 31, 2009, CMS eliminated the discretionary use of the DR and CR codes and announced that change in MLN Matters article MM6451.

Therefore, only providers and suppliers who have a formal waiver can use the DR condition code and CR modifier for their H1N1 or other claims. Providers who are appending one or both of these codes to claims and do not have a formal waiver allowing them to do so will face delayed payments, CMS says.

More information on the CR and DR codes is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6451.pdf.

 If you haven't signed up for the latest home health quality improvement (HHQI) campaign, you're missing out on free tools to help improve your agency's performance. The new HHQI campaign headed by CMS contractors WVMI and Quality Insights has issued its first best practices package, NAHC notes. The package takes aim at an important topic, Introduction and Fundamentals of Reducing Avoidable Hospitalizations.

More than 4,000 agencies have joined the campaign so far, NAHC reports. You can register for the campaign and log in for your best practices package at www.homehealthquality.org.

• Home care providers that are having trouble meeting the requirements for the Joint Commission's National Patient Safety Goal on medication reconciliation have a while longer to get their acts together.

The Oakbrook Terrace, Ill.-based accrediting body already postponed the use of the NPSG in organizations' accreditation decisions, it notes in a post on its Web site. Now it is putting off a field review of the goal while a revised version of it goes to the Standards and Survey Procedures Committee for approval this spring, notes the Joint Commission, formerly known as JCAHO.

• National Provider Identifiers continue to cause problems for providers, but now CMS wants to clear up your NPI trouble spots with a helpful new resource.

You can consult a new four-page brochure, "The National Provider Identifier (NPI): What You  Need to Know," CMS has announced. It offers tips on how to determine whether you need an NPI, how to get one, and how you can access the NPI registry.

The booklet is online at www.cms.hhs.gov/MLNProducts/downloads/NPIBooklet.pdf.

• Smart providers will include a manifest when submitting documentation for medical review, indicates a new question-and-answer from regional home health intermediary Palmetto GBA.

A hospice complained to Palmetto because it submitted records for multiple ADR'd claims in one envelope, according to the latest set of Hospice Coalition Q&As posted on the RHHI's Web site.

When Palmetto received the envelope, one chart was lost and the hospice was notified it didn't submit documentation by the deadline. Thus, the denial went into the provider's denial rate.

"Providers are encouraged to include a manifest when submitting multiple records together," Palmetto says in the Q&A. Also, "each record should be bound individually."

In this scenario, Palmetto's medical review staff will work with the provider to try to find the lost record and resolve the issue, the intermediary adds in the Q&A.

• Don't be surprised when you have to come up with a new Direct Data Entry (DDE) password, advises RHHI Cahaba GBA. "If you use DDE your password will expire periodically and you will need to change it," the intermediary says in a message to providers.

But you can't just use the name of your dog. Your new password must have at least one uppercase and lowercase letter, at least one number, at least one special character (@, #, or $), and be exactly eight letters long including the numbers and characters, Cahaba instructs.

Tip: If your user ID gets revoked, you'llneed your "RACF ID" and your PIN to reset it. Your RACF ID is the ID you use to access DDE (two letters and five numbers) and your PIN was assigned to you on your application for EDI services. If you can't find your PIN, you can get a new one using the EDI System Access Update Request form on Cahaba's Web site, the contractor says.

• Know how to list the state when submitting claims or risk payment delays. "When entering the beneficiary's state on the claim, only the two-letter state code should be entered," Palmetto instructs in a message to providers.

Otherwise, you'll receive error code H50002 in the claims crossover system, the RHHI warns. "When claims are submitted to Medicare with the name of the state spelled out rather than the appropriate two-letter state abbreviation (e.g., Texas as opposed to TX), error code H50002 fires from the claims crossover system," Palmetto explains on its Web site. "When this edit fires, the claims do not cross over into the beneficiary's secondary insurer's claims processing system."

The error code also occurs if the beneficiary state field is left blank, Palmetto adds.

• Orlando, Fla.-based Rotech Healthcare Inc. has won an $88.2 million contract for oxygen and DME with the U.S. Department of Veterans Affairs, the government reports. The contract is for a base year that starts next month, plus four option years, for the VISN 18 area in Arizona, New Mexico, West Texas, and small areas of Colorado, Kansas, and Oklahoma, according to the contract information on fedbizopps.gov.

• You could have an easier time getting intake data and other patient information if electronic health records take off, notes a new Government Accountability Office examining the safety of protected health information (PHI) under shared electronic records systems.

"The use of information technology to electronically collect, store, and share patients' personal health information could help providers obtain information about patients more quickly than they can in the current medical records environment," the report says. Currently, "the fragmented and inaccessible state of medical information can adversely affect the quality of health care and  compromise patient safety," particularly for patients with chronic health problems, the GAO notes. See the entire report at www.gao.gov/new.items/d10361.pdf.