Home Health & Hospice Week

Your supplies payment depends on how well your clinicians and billers communicate.

Fine tune your nonroutine supplies processes so you don't miss out on significant reimbursement after the short-lived grace period concludes.

Home health agencies may be in a NRS edit grace period now, but all too soon mistakes with NRS claims will be taking money out of your pocket. Use these tips from NRS experts to get your supplies billing up to snuff:

1) Know what counts. Your staff need to understand the difference between routine and nonroutine supplies, says M. Aaron Little with BKD in Springfield, MO. You must report NRS charges on claims, while routine supplies are bundled into the PPS episode rate and aren't reported separately.

This is the most common NRS question agencies ask, said NRS expert Lynda Laff in a recent Eli-sponsored audioconference about supplies.

The Centers for Medicare & Medicaid Services says NRS are "those supplies needed to treat a patient's specific illness or injury in accordance with the physician's plan of care," said Laff, with Laff Associates in Hilton Head Island, SC. Basically that means supplies that are specific to a patient and require an order.

CMS says routine supplies are "those supplies customarily used during the course of most home care visits. Routine supplies are usually in-cluded in the clinician's supplies and not designated for a specific patient," Laff continued. Examples are thermometers, alcohol swabs, applicators, infection control supplies and lab draw items, she said.

2) Get your NRS use straight. Your agency must be able to accurately record the NRS it furnishes to patients. For some agencies, that's as simple as creating a supply sheet for clinicians and educating them on how to correctly report the supplies, says consultant Michelle Enger with Optimal Reimbursement Strategies in Clearwater, FL. For others, a complex change to their computer system to facilitate internal supplies reporting is needed.

Adequate processes must be in place to ensure you are consistently recording NRS charges and that that information is always flowing to final claims, Little advises.

You must verify "whether controls, communication and processes are effective and efficient," he tells Eli. Billers must "be confident that if NRS do not flow over to final claims, it's because NRS were not provided to the patient rather than a communication/process breakdown or software system error."

Your clinicians need to know how PPS reimbursement works to emphasize why it's important that they diligently record NRS charges and code the patient correctly to obtain the correct NRS payment level, Laff emphasized.

3) Know how to bill. HHAs have only two supplies codes to use on claims--0027 for general supplies or 0623 for wound care supplies. And agencies must report units and charges for the supplies, regional home health intermediary Palmetto GBA instructed in a recent Ask-The-Contractor teleconference about PPS billing changes. HHAs were always supposed to bill for supplies under PPS, but there was no enforcement of this requirement, the RHHI noted.

Charges should include the cost of the supplies and your markup, Little says.

Even though the amount you get paid for NRS doesn't relate to the charges you report, it's still in your best interest to be as accurate as possible. CMS and other policymakers will use NRS data from claims to set future PPS payment rates, Little noted in a recent Eli-sponsored audioconference on PPS reimbursement.

4) Start out with NRS. Always use an alphabetic fifth HIPPS code digit on your request for anticipated payment, Little counseled in the audioconference. An S-X in the fifth position indicates you are furnishing nonroutine supplies in the episode.

CMS has revised the requirement for the RAP and final claim HIPPS codes to match, he said. Now the fifth digit may change between the two claims. You can determine at final claim time whether you furnished NRS or not and change the code if necessary.

5) Manage your supplies. Take a comprehensive look at your operations surrounding supplies, Laff suggested. Are you managing supplies by the patient or buying in bulk? Does your staff have to enter NRS data in multiple places, duplicating effort? Figure out the most streamlined processes and procedures for NRS.

6) Assess overall cost. Sometimes agencies focus on the cost of supplies instead of the overall cost to the agency for a patient. For example, daily wound dressing materials may be cheaper but require costly daily visits by skilled staff. More expensive wound care products may turn out to be cheaper to the agency overall if they cut down on unnecessary visits and speed healing, Laff explained.

In most situations, wet-to-dry wound care dressings that require daily visits aren't necessary and slow wound healing, she stressed.

7) Don't overlook these NRS point items. Agencies sometimes get wrapped up in the diagnosis codes and wounds for NRS points and forget about some other important NRS point-generators: ostomies, IV therapy at home, urinary catheter and bowel incontinence (responses 4-5), Laff highlighted in the conference.

Check out Table 10A in the 2008 PPS final rule for exact point levels for each item.

8) Tackle one area at a time. If your HHA needs an entire NRS overhaul, it's best to address the billing end first, Laff advised. Look at your current supplies billing procedures and update them where needed. Educate billers so they know about this important change and how it affects reimbursement, especially once the Oct. 1 deadline passes.

Then turn to your clinicians to assess OASIS accuracy. You should use real-time OASIS edits that flag inconsistencies that could rob you of your rightful PPS reimbursement, Laff advises.

And clinicians should understand how their accurate OASIS coding brings in the dollars needed to treat patients. Make sure they "see how closely intertwined the knowledge about the clinical care is to revenue," she urged.