Home Health & Hospice Week

Get ready to defend your HHA claims if you're using teaching as a skilled service.

In the prospective payment system 2010 update final rule, the Centers for Medicare & Medicaid Services clarifies what sort of teaching counts as a skilled service for coverage purposes.

"Skilled education services would be deemed to no longer be needed when it became apparent, after a reasonable period of time, that the patient, family, or caregiver could not or would not be trained," CMS says in the rule published in the Nov. 10, 2009 Federal Register. "Further teaching and training would cease to be reasonable and necessary in this case, and would cease to be considered a skilled service." Home health agencies may easily overlook this change, cautions Chicago-based regulatory consultant

Rebecca Friedman Zuber. In the same section, CMS made another coverage change that will hit many agencies harder -- the requirement for a physician narrative when evaluation and management services are a patient's qualifying skilled service (see stories, Eli's HCW Vol. XVIII, No. 41, p. 314 and No. 42, p. 324).

HHAs won't be on the hook for the patient's episode if teaching doesn't end up working, CMS assures agencies. They just have to stop teaching when the education isn't succeeding. "The services for teaching and training would be considered to be reasonable and necessary prior to the point that it became apparent that the teaching or training was unsuccessful, as long as such services were appropriate to the patient's illness, functional loss, or injury," CMS says.

The problem: Commenters on the PPS proposed rule didn't like the vague wording of this new restriction. "Some commenters asked that CMS better clarify timeframes that would be appropriate for these skilled training services," the rule notes. "Other commenters stated that unless CMS defines what is a 'reasonable period of time,' the clarification isn't helpful."

But CMS isn't going to dictate a certain timeframe, it says in the rule. "We believe it inappropriate to assign specific timeframes for patient education services," it says. That's because "the length of time a patient or family or caregiver needs should be determined by assessing each patient's individual condition and other pertinent factors such as the skill required to teach the activity and the unique abilities of the patient."

The bottom line: "Medicare's home health benefit is not intended to provide training and education to patients, families, caregivers for an infinite period of time," CMS says. Also, the policy merely codifies longstanding Medicare guidance, the agency maintains.