Home Health & Hospice Week
OBTAIN SPECIFIC FREQUENCIES OR FACE CLAIMS DENIALS
Intermediary cracks down on vague plans of care.
Your reimbursement is riding on the details in the plan of care for your patient.
Regional home health intermediary Cahaba GBA reminds providers that the plan of care can't have a vague visit frequency, according to the RHHI's De-cember newsletter to providers.
"The order on the plan of care must specify the type of services to be provided to the patient," Cahaba instructs. It must include the professional who will provide the services, the nature of the individual services (such as skilled nursing), and the service frequency.
Don't: An example of unacceptable orders is "10 SN visits per 60 days or 4-5 SN x mo2," Cahaba explains in the newsletter.
Do: Correct orders that include duration and frequency will read "SN x 7/wk x 1wk; 3/wk x 4wk; 2/wk x 3wk., or with a range SN x 2-4 x 4wk; 1-2/wk x 4wk," Cahaba offers.
"There is potential for denial of services when a written order does not include the specific frequency of visits," Cahaba warns.
The newsletter is at www.cahabagba.com/part_a/education_and_outreach/newsletter/1206_rhhi.pdf.
• The Joint Commission on Accreditation of Healthcare Organizations is considering a new round of National Patient Safety Goals for 2008.
"The National Patient Safety Goals, which are updated annually, are designed to require health care organizations to protect patients from the negative impact of specific health care errors," the Oakbrook Terrace, IL-based accrediting body explains.
Draft goals include requiring providers to: improve recognition and response to changes in a patient's condition; reduce the risk of post-operative complications for patients with obstructive sleep apnea; prevent patient harm associated with health care worker fatigue; and prevent catheter misconnections.
JCAHO is also considering goals regarding re-duction of anticoagulation therapy risks and technology to assist with patient identification.
Comments on the proposed goals are due by Jan. 26. More information, including instructions on how to comment, is at www.jointcommission.org.
• The Centers for Medicare & Medicaid Services is gearing up to test its post-acute care patient assessment instrument. CMS plans to launch a demonstration project testing the instrument and its ability to help place patients in the most appropriate post-acute setting, the agency says in a release.
CMS is holding a special Open Door Forum about the instrument and demo Dec. 21. The agency wants provider feedback on the instrument, which will be designed for use starting at hospital discharge, and completed at inpatient rehabilitation facilities, skilled nursing facilities, home health agencies and long-term care hospitals.
More information on the instrument is at www.cms.hhs.gov/SNFPPS/Downloads/pac_reform_plan_2006.pdf.
• Suppliers of durable medical equipment, prosthetics, orthotics and supplies have a new Medicare fee schedule.
CMS released the new payment amounts on Dec. 8. The DMEPOS fee schedules are updated annually in accordance with the statute and regulations.
To see the new fee schedule, go to www.cms.hhs.gov/DMEPOSFeeSched/.
• If you're having trouble competing against hospitals for aides, pay rates could be a big reason why.
The national hourly rate for hospital certified nurse aides is $11.49, according to the 2006-2007 Nursing Department Report from the Hospital & Healthcare Compensation Service. That compares to $11.00 for home health aides and $10.33 for nursinghome aides, HCS says in the report drawn from more than 4,200 facilities' data.
Turnover for hospital and home health aides is about the same--24.97 percent versus 24.87. But nursing home CNA turnover was a whopping 42.75 percent, the report says.
More information is at www.hhcsinc.com.
• The Washington D.C. Department of Health could have saved $34 million on nursing home costs in 2002 through 2005 by offering a home care Medicaid waiver, according to an Inspector General report. The audit found that the average yearly cost of nursing home care was $75,600, compared with $10,000 for annual home care costs for comparable services, reports the Washington Post.
"The purpose of maintaining the elderly and adults with physical disabilities in their homes is ... two-fold," the report says. "First, many people maintain a higher quality of life in their homes with assistance from direct care providers. Second, the cost of home health care is much lower than the cost of nursing home care."
• Pediatric Services of America Inc. reported a loss of $1.3 million on revenues of $31.9 million for the quarter ended Sept. 30. But the Norcross, GA-based company says it has shed its extraneous businesses and is now focused on its core business of pediatric nursing as PSA Healthcare.
PSA has signed an agreement to acquire the assets of Texas provider Advanced Pediatric Care Inc., the company says in a release. PSA plans to pay $600,000 in cash with Advanced Pediatric retaining its accounts receivable. The company expects the acquisition of Advanced Pediatric, which has about $1.5 million in annual revenue, to close in January 2007.
• Hospice chain VITAS has opened a location serving the Richmond, VA area, it says in a release. Miami-based VITAS operates 41 hospice programs in 16 states with more than 9,000 employees.
• A Houston-area psychiatrist wound up with a six-and-a-half year prison sentence for his role in a motorized wheelchair fraud scheme, a federal judge announced recently.
Lewis Gottlieb must also pay more than $20.6 million in restitution and forfeit to the government an additional $19 million that came from the proceeds or property derived from the wheelchair fraud scheme, according to Donald J. DeGabrielle Jr., U.S. Attorney for the Southern District of Texas.
The judge returned the decision in the case (United States v. Gottlieb, S.D. Tex., No. CR-H-03-0369) on Dec. 5.
Gottlieb was one of six individuals indicted in 2003 for allegedly participating in a multimillion-dollar scheme with DME suppliers and recruiters to defraud Medicare and Medicaid.
• You'd better keep a close eye on your therapist contractors or you may owe money back to Medicare. That's what three unnamed home health agencies in Massachusetts found out when their therapist was prosecuted for Medicare fraud.
Therapist Ho Ling Lai purported to be providing physical therapy to different patients of three different HHAs at the same time, on the same day, but in different towns, according to a release from U.S. Attorney Michael J. Sullivan. The agencies billed Medicare for $55,000 based on her false time sheets and had to repay that amount, Sullivan says.
Ling pleaded guilty last July as part of a plea agreement and agreed to pay $32,000 in restitution. Last month, U.S. District Judge Reginald C. Lindsay sentenced Ling to three years' probation, including five months in home detention with electronic monitoring, and a fine of $3,000, the release says.
Home Health & Hospice Week
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OBTAIN SPECIFIC FREQUENCIES OR FACE CLAIMS DENIALS
Intermediary cracks down on vague plans of care.
Your reimbursement is riding on the details in [...]
