Home Health & Hospice Week

Do you wish you could have more claims in medical review? Not likely, but that's what could happen if you don't get up to speed on M0175 accuracy.

Nationwide pre-payment edits for the OASIS item on prior hospital stays, mandated by the Centers for Medicare & Medicaid Services, are set to begin April 1. And regional home health intermediaries will collect fiscal year 2001 and FY 2002 M0175 overpayments this year, CMS tells Eli.

Home health agencies have big questions on how and when CMS is going to make those recoupments, notes Pat Sevast, consultant with American Express Tax & Business Services in Timonium, MD. "Most of [the takebacks] are going to be a surprise" to agencies, Sevast predicts. "They submitted their OASIS and they thought it was correct."

If agencies fare badly in M0175 edits, they can expect probe reviews and focused medical review of their claims, Sevast expects. That will mean long waits for their rightful reimbursement.

To increase M0175 accuracy, experts offer these tips:

1. Focus on intake procedures, recommends Mary St. Pierre of the National Association for Home Care and Hospice. Sevast recommends putting emphasis on intake questions rather than common working file checks, because CWF data will be helpful only once the hospital has billed. That usually won't be the case at admission, she believes.

HHAs should instruct intake staff to ask questions about hospital stays, St. Pierre advises. And to get staffers to focus on the issue, smart HHAs will add questions to their intake forms that require an answer, Sevast says.

Asking a referring facility for hospital discharge information is likely to be more reliable than asking the patient herself, Sevast adds. "Facilities are more likely to have exact dates of discharge."

2. Follow up with OASIS staff. Tell the clinicians filling out OASIS to ask about hospital and other facility stays, even if intake hasn't ID'd them, St. Pierre counsels. Be sure to emphasize that staff must mark all that apply, not just the most recent stay.

Especially careful questions should be applied when patients come from a rehab facility, Sevast urges. "Most of the time, it's hospital-to-rehab-to-home."

3. Audit M0175. Include the crucial OASIS item on in-house OASIS verification audits, St. Pierre instructs.