Home Health & Hospice Week

OASIS accuracy counts heavily for NRS.

With separate payment for non-routine supplies hitting Jan. 1, now's the time to prepare for the major reimbursement change--or risk your bottom line.

Even though it is not ideal, the Centers for Medicare & Medicaid Services' plan to reimburse NRS using severity levels and diagnoses plus other OASIS items as indicators is a sound methodology and a good start, cheers consultant Judy Adams with LarsonAllen in Charlotte, NC.

"The approach to the NRS payment is still a long way from where it needs to be," acknowledges consultant Mark Sharp with BKD in Springfield, MO. "But it is a step in the right direction to try to get payment for supplies to those episodes that utilize supplies."

Heed these tips from the experts to make the most of the new NRS payment system and control supply costs:

1. Increase OASIS accuracy. Under the PPS refinements, reimbursement for NRS flows from the OASIS assessment, Adams explains. For agencies to receive appropriate NRS reimbursement, accurate assessment is very important, she warns.

Example: An ostomy related to an inpatient stay or regimen change is worth 35 points toward the NRS severity rating, Adams explains (see Eli's HCW, Vol. XVI, No. 31, for scoring levels). But an ostomy not related to an inpatient stay or regimen change adds only 21 points. Determining exactly which category the patient fits into at start of care can gain or lose reimbursement dollars.

Accurate NRS severity rating helps compensate for changes in reimbursement under the 2008 PPS system, Adams says. Pressure ulcer and stasis ulcer M0 answers are worth less in the clinical domain under the new system than in the current system, she notes. So getting the correct number of NRS points is especially important.

Pressure ulcer scenario: A patient with one Stage 3 pressure ulcer (M0450) scores 31 points, while one Stage 4 pressure ulcer scores 52 points.

If the patient has three or more Stage 3 pressure ulcers, you get 57 NRS points. But three or more Stage 4 pressure ulcers adds 104 points. Even if the patient has no other NRS points, the difference between 57 and 104 points translates into $230 of payment, Adams says.

Stasis ulcer scenario: First, you get points for the number of stasis ulcers (M0470) and then add points for their status (M0476). In the final rule, a stasis ulcer that is "early/partial granulation" adds 18 points, while "not healing" adds 28 points, Adams illustrates.

2. Search for the best supplies deal. "Agencies need to shop for the best supply vendors, price and delivery," counsels consultant Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas.

3. Establish practice standards. Reimbursing agencies for NRS is "a huge change," says consultant Pat Laff with Laff Associates in Hilton Head, SC. Your operations will need to change along with it.

 Providers should set up standards of practice that guide supplies utilization, Laff advises. The standards should address the number and type of supplies by diagnosis.

4. Do not let clinicians take out more than three days of supplies. This prevents "piles of supplies in the patient's home" because a treatment protocol has changed, explains consultant Debbie Dawson with HealthCare Strategies in Chattanooga, TN.

5. Limit supplies you take to those needed. If you need 4x4s, gloves and tape for dressing changes, don't take tape every week just because it is on the list, Dawson urges. A roll of tape may last for several weeks.

6. Don't use sterile when clean will do. Determine if sterile technique is actually necessary in the home treatment you are doing, Dawson instructs. If not, don't spend extra on sterile supplies.

7. Set up a system requiring an order to check out a supply. "The extra time this takes will more than be offset by the savings in supplies that no longer have to be written off for lack of an order," Dawson says.

8. Track medical supplies by the patient. Allocate supplies costs to the patient who uses them, recommends consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN.

9. Follow the manufacturer's recommendations. This is especially important for expensive supplies. Many clinicians try to "'save' or 'stretch' expensive dressings by skimping or cutting," Dawson reports. But this can undermine the dressing's effectiveness and lengthen healing time, she says.