Reimbursement:
Buddy-Up With Hospital Billers To Nail M0175
Published on Thu Aug 26, 2004
Check out these experts' tips for getting the crucial OASIS item on inpatient stays right the first time. Up to $550 per patient could be riding on each M0175 answer you complete, and with the HHS Office of Inspector General breathing down agencies' necks on the topic, now's the time to get it right.
Here's how it works: To obtain the extra $150 to $250 for non-therapy patients and $450 to $550 for patients who break the 10-visit therapy threshold, home health agencies must mark that there was no hospital discharge and that a rehab or skilled nursing facility discharge occurred in the 14 days before admission, explained M. Aaron Little at an Aug. 24 teleconference sponsored by Eli Research and The Coding Institute.
HHAs can use the common working file to ferret out prior stay information for patients, said Little, a consultant with BKD in Springfield, MO (see Eli's HCW, Vol. XIII, No. 17, p. 130 for instructions on how to use the CWF). But agencies run into a brick wall if the "FULL HOSP" column on the ELGA screen shows less than 60 days, because the data doesn't indicate whether the hospital stay was an acute inpatient stay (Response 1 on M0175) or a rehab stay (Response 2).
You can always ask the patient and her family members what type of facility the patient was in, BKD's Karen Vance said in the teleconference. But chances are they'll be fuzzy on the details, especially if the patient was in a swing bed or in a long-term care hospital that sounded like a rehab facility but really counts as an acute hospital for M0175 purposes.
When "FULL HOSP" indicates an unclear stay, the hospital billing department could become your best friend. There is a simple way to determine the patient's type of stay, Little instructed: Check the bill type the hospital is submitting for the patient.
Tip: If you make some good contacts at the hospital billing department, they should easily be able to tell you if the bill they submit for the patient is "1xx" indicating a hospital stay, or "11x" indicating a rehab stay, Little advised. For example, if the type of bill is 112 or 113, that shows you it was a rehab stay, he said.
An added bonus to checking this information with the hospital biller is that you can often get it before the hospital even sends out its bill, Little added.
It's vital for HHAs to answer M0175 correctly, Little noted, because from January 2004 forward, the Centers for Medicare & Medicaid Services will not automatically correct underpayments based on the OASIS item (see Eli's HCW, Vol. XIII, No. 28, p. 218). So if agencies miss a rehab or SNF stay [...]
