Home Health & Hospice Week

Tip:  Avoid human error with pre-printed information.

You'd better make sure your mandatory expedited determination notices pass muster--or you'll pay the price.

If the Quality Improvement Organization finds that the first-step, generic expedited determination (ED) notice you give patients is invalid, the liability clock restarts when you deliver a second, corrected notice, the Centers for Medicare & Medicaid Services explains in newly issued questions and answers on the notices.

"If a provider fails to correct an invalid notice, the provider may be held liable for subsequent noncovered care," CMS explains in the Q&A. "QIOs will not address whether coverage should end or continue until beneficiaries receive valid notice."

In other words, you can't bill the patient for any services until two days after you give the corrected, valid notice, explains consultant Judy Adams with LarsonAllen Health Care Group based in Charlotte, NC.

Watch out: This clarification "potentially prolongs the amount of time that a beneficiary receives care before the determination is made," warns Casey Blumenthal with MHA...An Association of Montana Health Care Providers. "It leaves everything in limbo, and an agency may end up providing several days of non-reimbursed care."

Fortunately, the first-step ED notices are straightforward and don't lend themselves to many errors, experts say. Home health agencies have to insert their own identifying information, the patient's name and Medicare number, the types of services that will end, the date the services will end, and the name and contact information for the QIO that will review the determination if requested.

Agencies' main problem with invalid notices is getting them delivered in the correct timeframe--at least two days before discharge, notes consultant Pam Warmack with Clinic Connections in Ruston, LA. Predicting the date of discharge "is not always an easy task," making an accurate delivery time difficult, War-mack tells Eli.

HHAs may also incorrectly list the services being terminated or the QIO information, suggests attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. But "if an agency is careful, it should not be a real problem," Markette expects.

Do this: Pre-print the QIO contact information on the forms so you minimize the chance for human error, Markette suggests. "This will reduce the possible areas for mistakes."

You can also hand out notices earlier than the two-day deadline to give yourself extra wiggle room should the QIO rule the notice invalid, Adams notes.

Many HHAs "are giving patients the ED notice when they anticipate the discharge and not waiting until two days prior to discharge," Adams reports. That way, "the patient is often receiving several days advance notice, but is not 'charged' for any services until after the discharge date."

Handing out notices a bit early may be easier for agencies now than it used to be. HHAs in the last [...]