Home Health & Hospice Week

Remember these delivery rule exceptions

Nearly three months into the expedited review notice requirements, you should be getting the hang of the new rules. But you could be wasting precious resources if you're overlooking some common ways to streamline your notice delivery process.

Regulations require home health agencies and hospices to deliver the first-step, generic expedited review notice to patients when their Medicare-covered services are ending. Providers must issue the notices at least two days prior to discharge, the Centers for Medicare & Medicaid Services instructs.

But there are some common exceptions to that rule, Burtsonville, MD-based health care attorney Elizabeth Hogue noted in a recent teleconference sponsored by Eli. You sometimes will need to suddenly discharge a patient without the two-day notice timeframe when the patient is found not to be homebound, for example. Or for hospices, discharge must occur if the patient is found to not have a terminal condition.

Remember: "Delivery of the notice is never supposed to delay discharge," Hogue told listeners. Don't keep the patient on service just to wait out the expedited review notice deadline.

When patients require sudden discharge, home care providers should not waste the time and resources sending staff out to deliver a notice that won't make the two-day timeframe anyway. Instead, agencies should notify the patient of the expedited review information via telephone and mail two copies of the notice to the patient as CMS allows, Hogue counseled. The patient should keep one copy and sign and return the other copy.

Requirements for sending the notices are unclear, Hogue lamented. But CMS instructions to intermediaries indicate regular mail is OK and registered mail is not required. Registered mail may be undesirable for this purpose because it is rather slow, she added.

Try this: Hogue recommended using regular U.S. mail with confirmation service that documents delivery of the letter but doesn't require a signature. That option can get the notice to the beneficiary as quickly and reasonably as possible and still prove delivery if necessary, she noted.

If you use an overnight delivery service such as FedEx or UPS to deliver the notice, you don't need a signature for the delivery, Hogue noted. But you may want to require one for proof of delivery anyway, she allowed.

End the Paper Chase

CMS requires providers to secure a copy of the signed first-step notice, Hogue pointed out. But returning signed forms back to HHAs is not likely to be a high priority for beneficiaries who are notified through the mail.

"There have to be some boundaries placed on our efforts to get these signed notices returned to the agency," Hogue maintained. Otherwise, providers will waste resources endlessly chasing down unsigned forms.

Tip: Although CMS has offered no specific guidance on the topic, Hogue recommended developing an internal policy requiring three reasonable attempts to secure the signed notice. After that, "cut it off," she advised. You must be sure to document your attempts, she added. 

Note: To order a recording or transcript of Hogue's teleconference, go online to http://codinginstitute.com/conference/tapes.cgi?detail=389 or call 1-800-508-2582.