Home Health & Hospice Week

If you want to protect your reimbursement for patients who transfer from another home health agency during their 60-day episodes, you're going to have to take some pretty laborious measures. Situations where patients transfer HHAs within an episode can get downright nasty, acknowledges Lynn Olson with billing company Astrid Medical Services in Corpus Christi, TX. Agencies that feel another provider stole a patient can "get mad and want to make that other provider suffer," Olson warns. The way they do it: refuse to either cancel an already-filed request for anticipated payment or submit the final claim that closes out the episode. Until "Agency 1" does one or the other, "Agency 2" - the agency that admitted the transfer patient - can't file its own RAP for the patient. Under the prospective payment system, only one HHA at a time can receive payment for the patient.

"Agencies will hold onto that RAP money for the 60- to 75-day loan" it represents while the second agency must cool its heels, Olson tells Eli. In extreme situations, Agency 2 must call in the regional home health intermediary to cancel Agency 1's claims so it can bill for the patient. Or sometimes Agency 1 argues that it should be paid for all of its visits to the patient, even if they overlap with Agency 2's visits. The RHHI also is called in to settle those types of cases. When settling transfer patient disputes, RHHI Palmetto GBA says it requires the agency that accepted the transfer patient to have three pieces of documentation. 1. A printout of the Health Insurance Query for Home Health (HIQH) screen. HHAs should check this screen for every patient and print it out even if it doesn't show an open episode for the patient, Palmetto says in a March 3 question-and-answer document with its 12-state home health coalition. If the patient later turns out to be a transfer patient and you failed to print out and save the HIQH screen documenting that no episode showed up, the other agency is entitled to the reimbursement. 2. Documentation that it informed the patient that two HHAs can't receive payment for the patient's services simultaneously. Even if the agency had no idea the patient was also being seen by another HHA, Agency 2 won't receive payment for the patient unless it informed the patient of this basic concept - and documented it in the record, Palmetto says in the Q&A posted March 24. 3. Documentation showing the name of the individual contacted at Agency 1, the telephone number, the date of contact and a brief description of the conversation. Palmetto requires this item only if another episode did show up in the HIQH [...]