Home Health & Hospice Week
PREPARE FOR NEW HH ABN FORM THIS FALL
CMS expects you to be issuing ABNs more than twice per episode, on average. Office of Management and Budget approval of the current HH ABN form expires Aug. 31 and the Centers for Medicare & Medicaid Services has proposed some minor changes for the new form that will take effect in September. Home health agencies won't have to wait until the fall to implement the new forms, however, CMS says in documents supporting its May 15 Federal Register notice about the change. "HHAs may begin using the reformatted HHABN as soon as possible," CMS explains. "Continued use of either form remains acceptable through a transitional period that is dependent on OMB approval of the reformatted version." Stay tuned for exactly what that transitional period date will be, CMS says. Tweaks: The minor changes CMS proposes for the HH ABN are banning patient HICN or Social Security Numbers from the forms in favor of patient ID numbers; preprinting Medicare phone numbers on the forms; and changing some spacing and text placement. CMS also wants to change the instructions to allow agencies to fill out a patient's name and ID number on the form instead of requiring the patient to do it herself. That should reduce HHA burden somewhat, the agency maintains. CMS estimates that HHAs issue 12.3 million HH ABNs a year. While only 8 percent of episodes require Option Box 1 or Option Box 2 HH ABNs, CMS expects HHAs to issue ABNs twice per episode for Option Box 3 (required when the ordering physician reduces services). "The 200 percent estimated use of Option Box 3 during annual 60-day episodes of care reflects the high number of care changes that occur due to doctor/provider orders," CMS explains. The proposed form and supporting materials are at www.cms.hhs.gov/PaperworkReductionActof1995/PRAL/list.asp -- scroll down to the May 15 entry for CMS-R-296. Comments on the changes are due to OMB by July 14. • Your home medical equipment claims will have to jump through more hoops regarding ordering physicians starting in October. CMS is tightening up its claims checks for ordering physician numbers, according to April 24 Transmittal No. 480 (CR 6421). In the first phase that starts Oct. 1, the durable medical equipment Medicare Administrative Contractors (DME MACs) won't pay claims that are missing the ordering/referring physician's National Provider Identifier. In January, the DME MACs will step up to denying payment for claims that have an ordering/referring physician NPI, but the NPI isn't on the valid list from the Provider Enrollment, Chain, and Ownership System (PECOS). The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R480OTN.pdf. • Hospices wondering how to improve utilization of hospice care may have to look only as far as treating physicians. In a new study in the Archives of Internal Medicine, Harvard Medical School researchers found that only about half of 1,500 patients with Stage IV lung cancer discussed hospice with a physician or other health care provider within seven months of diagnosis. "Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice," the study abstract notes. "You have a lot of doctors out there who weren't trained in these conversations about end of life or breaking any kind of bad news, whether it's a prognosis or difficult treatment," Dr. JoAnne Nowak, medical director of Partners Hospice and Palliative Care in Boston, told the Boston Globe about the study's findings. "Many terminally ill patients enroll in hospice only in the final days before death or not at all,"the study authors note. "Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use." • Home care proponents continue to advance the industry's agenda in Congress. Sens.Susan Collins (R-Maine), Blanche Lincoln (DArk.), and Kit Bond (R-Mo.) have introduced legislation (S. 1123) to restore the 5 percent rural add-on for Medicare HHAs for five years. The rural add-on expired in 2006, notes the National Association for Home Care & Hospice. "There are additional challenges to reaching patients in rural and remote areas of our nation," says NAHC's Val Halamandaris. "Home care is often the only lifeline these patients have to health care." • One big headache caused by Medicare's new requirement for hospice visit charges may soon get better. Last year, CMS began requiring hospices to list visit charges on their claims, the agency notes in April 24 Transmittal No. 471 (CR 6386). The claims system processes these visit charges as non-covered and they show up on the remittance advice and beneficiary Medicare Summary Notice (MSN). The misleading RAs and MSNs have caused some secondary payors to make inappropriate payments for the charges and some beneficiaries to believe they owe for the charges and appeal them, CMS relates in the transmittal. Change: "To minimize confusion ... Medicare will change the outcome of processing these charges to reflect as covered on the remittance advice notice and the MSN," CMS says. The change takes effect Oct. 1. NAHC is pleased that CMS is alleviating the problem, the trade group's Janet Neigh tells Eli. • Don't be surprised if you have to respond to some ADRs twice. That was the message from regional home health intermediary Palmetto GBA in a recent Ask The Contractor session. In this scenario, an HHAcould send in additional development request documentation for medical review and reviewers could approve the claim and send it on for processing. Then, the claim could be rejected for a processing error. In that case, the provider would need to resubmit the claim, which could generate a second ADR. "The provider would need to resend all the requested medical records for a second time to Palmetto GBA," the intermediary confirms. • If you're looking for help on what discharge code to use for hospice patients who die in the nursing home, you need to keep looking. One hospice asked RHHI Cahaba GBA which discharge code to use for a patient who expires in a skilled nursing facility where they are residing: 40 (expired at home) or 41 (expired at medical facility). CMS and the National Uniform Billing Committee (NUBC) don't provide a definition of a patient's place of residence in regard to the patient status codes, Cahaba says in its May newsletter for providers. "Therefore, because the patient status codes...are not used to determine reimbursement or coverage, we suggest that you use the code you believe to be the most appropriate," Cahaba advises. • Indianapolis-based Arcadia Resources Inc. has sold its Home Health Equipment (HHE) business line to focus on its Arcadia Home Care/Medical Staffing and DailyMed pharmacy services divisions, the company says in a release. "The recent government reimbursement changes in Home Health Equipment ... created further operational challenges for us," Arcadia CEO Marvin Richardson says in a release. "By divesting these assets and focusing our attention on our higher growth and higher profit-potential areas, we expect to build value more quickly." • The Accreditation Commission for Health Care is extending its home care accreditation program to sleep labs, the Raleigh, N.C.-based accreditor says. The program applies to both freestanding and hospital-based labs, it says in a release. • Don't get confused if your "HOME" key isn't doing what it usually does in the Direct Data Entry (DDE) system. From June 1 to July 6, providers served by RHHI Cahaba GBA will see their HOME key in the DDE entry and inquiry screens default to the "SC" field instead of the "PAGE" field, the intermediary says in an e-mail message to providers. "Please note that this change is temporary,and is a result of permanent screen modifications that are being made to the FISS DDE screens,"Cahaba says. "The 'HOME' key will default back to the 'PAGE' field July 6." The permanent DDE changes will include changes to the top lines of the screens to standardize all screens' appearance, Cahaba explains.
Home Health & Hospice Week
- Patient Satisfaction:
CATCH A SNEAK PEEK AT YOUR P4P MEASURES
New patient satisfaction survey has four big flaws, reps point out. You may not have [...] - Fraud & Abuse:
FEDS TURN UP THE ENFORCEMENT HEAT ON HOME CARE PROVIDERS
Will legitimate providers get caught in the crossfire? You've got your eye on the RACs, [...] - Prospective Payment System:
PPS FLEXIBILITY COULD BACKFIRE ON HHAs
High exec salaries add fuel to HHA payment cut fire. Exorbitant executive salaries under the [...] - Diagnosis Coding:
DON'T COUNT ON MUCH WIGGLE ROOM FOR ICD-10 DEADLINE
Plus: Home care shouldn't rely too heavily on CMS's ICD-9 to ICD-10 crosswalk tool. Although [...] - Education:
GET A HEAD START ON TRANSITION TO ICD-10
Map out your staff training on coding for the coming year. While Oct. 1, 2013 [...] - Industry Notes:
PREPARE FOR NEW HH ABN FORM THIS FALL
CMS expects you to be issuing ABNs more than twice per episode, on average. You [...]
