Home Health & Hospice Week

Watch out: Refusing therapy may make your patient ineligible for home care at all, recent audit suggests.

Beware if your files include patient scenarios similar to those outlined in the latest HHS Office of Inspector General report:

Case #1: The patient “had been hospitalized for approximately 1 week for severe abdominal pain and was treated for a small bowel obstruction and could ambulate 150 feet and negotiate stairs safely without an assistive device. He had good balance and functional endurance and his total Tinetti score was 26/28,” the OIG recounts.

Judgment #1: “Leaving the home would not have required a considerable or taxing effort,” the reviewers found. “The beneficiary was not homebound at the start of care or during the episode.”

Case #2: “A beneficiary in her first episode of care with comorbid medical conditions including severe depression, anxiety, and osteoarthritis was homebound. Her conditions were longstanding and there was no history of recent injury. She had caregiver assistance available for processing information with respect to education regarding her medical conditions. The patient was not consistent with her home exercise program, refused to ambulate with staff by using her wheelchair to attend meals, and refused therapy at times.”

Judgment #2: “Ongoing skilled nursing and physical therapy services were excessive and not medically necessary after the third visit,” reviewers said.