Home Health & Hospice Week

Now is the time to beef up your M0175 information-collection practices, before edits of the OASIS item affecting billing hit in April.

In addition to adding some pointed questions to the intake process (see story, "OASIS:  Use CWF to Answer"), home health agencies should check the common working file for patients' prior hospital, skilled nursing facility and rehab facility stays, recommends consultant M. Aaron Little with BKD in Springfield, MO. "While the thought of doing each of these items is overwhelming, each step is important and should become part of the admission process from intake through completion of the comprehensive assessment," Little says.

An official from the Centers for Medicare & Medicaid Services tells Eli a forthcoming CMS education article will explain to HHAs how to check the CWF for hospital and SNF stays. But many agencies want to start now.

They can follow these steps from Little to make the most of their CWF access:

1. Locate HIQA Page 1. You can access all the prior stay information on this page.

2. Look under the "CURRENT" line. There you should see two columns: "FULL-SNF" and "CO-SNF." The "FULL-SNF" column represents the first 20 days of a Medicare SNF stay, which are fully covered by the program. The "CO-SNF" column represents the last 80 days of a Medicare SNF stay, which are only partially covered and require coinsurance.

3. Determine how many days are under each SNF column. If the days are to their limit - 20 and 80 respectively - then the patient didn't have a SNF stay and you can stop. If the days are under the 20/80 limit, then a SNF stay most likely occurred and you should proceed to Step 4.

"If you see SNF days of less than 100 (the SNF benefit limit), then the discharge date will typically be discharge from the SNF," agrees the CMS official.

4. Check the discharge date. Even if there was a hospital and/or SNF stay, it affects M0175 and billing only if it was within 14 days of home health admission. To check the discharge date, locate the "DOEBA" and "DOLBA" columns under the "CURRENT" line. "DOEBA," the "date of earliest billing action," normally represents the date the patient entered an acute hospital stay. "DOLBA," the "date of latest billing action," represents the discharge date of either an acute hospital stay or a SNF stay, if the amount of days left for SNF coverage is less than 20/80.

5. Compare the dates. Compare the date under "DOLBA" to the home health admission date to see if it falls within 14 days of admission and therefore affects M0175 and related billing.