Home Health & Hospice Week

One intermediary overpaid HHAs by $2 million in 2001 alone, based on incorrect OASIS responses. It's not enough that home health agencies must withstand takebacks for partial episode payment adjustments (PEPs); now they should prepare for millions in recoveries due to inaccurate answers to OASIS item M0175. That's what the HHS Office of Inspector General recommends in a new report examining the impact of incorrect responses to M0175, which asks about a patient's inpatient stays within 14 days of home health admission (A-01-03-00500). The OIG examined a sample of 200 claims from fiscal year 2001 for which regional home health intermediary Associated Hospital Service of Maine paid a higher amount based on M0175. Out of those 200 claims, there was $77,461 in overpayments based on wrong responses, the OIG says. Extrapolated to the more than 6,000 higher-paying claims for that year based on M0175, AHS overpaid about $1.9 million based on the OASIS item, the watchdog agency estimates. The overpayments come about when HHAs fail to mark all the correct responses to M0175. If they mark that the patient had a rehab or skilled nursing facility discharge without also marking that the patient had a hospital discharge in the 14-day time period, the episode receives an extra point in the service utilization domain. That extra point bumps the HIPPS code up from a "J" or "L" in the fourth position to a "K" (without therapy) or "M" (with therapy), the OIG explains in the report. In two examples the OIG used, that results in an extra $200 for a non-therapy patient and an extra $600 for a therapy patient.  HHAs At Fault For M0175 Errors, OIG Charges  Agencies are marking M0175 incorrectly because they overlook the hospital discharge preceding the rehab or SNF discharge in the two-week period, or because they fail to gather accurate discharge data from the beneficiary, family member/caregiver or referral source, the OIG concludes. Clinicians often are in a rush to complete the OASIS assessment while they are in the home, so they can get to the more clinical part of the visit, says OASIS expert Karen Vance, a consultant with BKD in Springfield, MO. That makes it easy to overlook two different discharges in the relevant time period. But often it's nigh impossible to extract the correct information out of the beneficiary, caregiver or referral source, HHAs argue. "Patients don't make the best historians," agrees Vance. "It is terribly hard in many cases to get reliable information from our patients and families," insists Bob Wardwell of the Visiting Nurse Associations of America. "Hospital referral staff are also overworked and difficult to reach." "Nurses deserve a pat on the back for ... going above and beyond to get [...]