Home Health & Hospice Week

OIG scrutiny and payment impacts make getting correct information on patients' prior inpatient stays a must.

If you're at a loss as to how to tighten up your M0175 information-collection practices, take heart - the common working file may be your best friend. It's important to obtain the correct information, because M0175 asks if the patient has been discharged from a hospital, skilled nursing facility or rehab facility within 14 days of home health admission. If the patient has had a hospital stay and a SNF or rehab stay in that time, but only the SNF or rehab stay was marked, payment for the patient goes down by as much as $600 for therapy patients and $200 for non-therapy patients. If they've had only a SNF or rehab stay that didn't get marked, payment for the patient can go up by the same amounts. Problem: The trouble is that home health agencies usually rely on receiving prior stay information from referral sources, patients and their families, which often results in inaccurate responses to M0175. Solution: Using the HIQA query screen for the CWF means home health agencies won't have to rely solely on hearsay for information on patients' prior inpatient stays, a Centers for Medicare & Medicaid Services official tells Eli. If you know where to look, the CWF can tell you a lot about a patient's history of inpatient stays.

No Fooling:  M0175 Edits Coming In April  This is a big help, because M0175 soon will be more important than ever. Beginning in April, the Medicare claims system will downcode your claims if the patient's claims history shows an unmarked qualifying hospital stay combined with a rehab or SNF stay (see Eli's HCW, Vol. XII, No. 39, p. 306). But it won't give you more money if you fail to mark just a SNF or rehab stay that had no accompanying hospital stay. In addition to the payment implications, the HHS Office of Inspector General and other fraud investigators have their eye on the M0175 issue, notes consultant M. Aaron Little with BKD in Springfield, MO. These "reinforce the necessity for accurate responses," Little says. Checking the CWF through HIQA should be an important part of ensuring your M0175 accuracy, but it "can require some detective work to decipher," Little admits. Some regional home health intermediary reps are telling agencies the information isn't available, notes Lynn Olson with billing company Astrid Medical Services in Corpus Christi, TX. But you just need to know the ropes, CMS and Little say. (For tips on figuring out the CWF, see "Reimbursement:  5 Steps" this issue).

Don't Rely Soley On CWF  Once you get the hang of it, using the CWF may make your M0175 information-gathering much [...]