Home Health & Hospice Week

Cut your costs with SCIC know-how.

Confusion over when to claim a SCIC--and when not to--could be costing your agency hundreds of dollars per episode.

When your significant change in condition percentage is higher than average, it's time to review your SCIC decision-making. First you must tackle the clinical definition of a SCIC.

Avoid unnecessary filing by carefully defining what constitutes a SCIC, advises consultant Lisa Selman-Holman with Denton, TX-based Selman-Holman & Associates. "Too many agencies define SCIC too broadly in their policies and then run themselves ragged doing OASIS assessments," she observes.

SCIC defined: The prospective payment system defines a SCIC as a "significant change in condition during a 60-day episode that was not envisioned in the original plan of care."

In an August 2001 letter to the National Association for Home Care & Hospice, the Centers for Medicare & Medicaid Services further clarified that an unanticipated change is one in which "the patient's condition, disease course and plan of care as predicted at the start of care changed significantly so that a new plan of care and case mix are needed to reflect the patient as different than [at] the start of care," NAHC reports.

Agencies may want to define a change in condition as one that changes the case-mix score, Selman-Holman suggests, although this definition requires understanding the M0 items that add case-mix points.

Do Your SCIC Math

Once you've decided what constitutes a SCIC, it's time to decide when you should claim one. Except in rare cases where a patient's condition unexpectedly improves, you must claim a SCIC only when it benefits you financially, reminds consultant M. Aaron Little with BKD in Springfield, MO.

Follow these steps offered by consultant Pam Warmack of Clinic Connections in Ruston, LA to ensure your agency files optional SCICs only when they will add to your bottom line:

1) Divide the episode payment for the pre-SCIC case-mix weight by 60 to get the pre-SCIC per-day payment amount.

2) Count the number of days from the start-of-care visit to the last visit before the SCIC.

3) Multiply that number of days by the per-day amount.

4) Divide the episode payment amount that the post-SCIC increased HIPPS code would provide by 60 to get the post-SCIC per-day payment amount.

5) Count the number of days from the first visit after the SCIC occurred (such as a resumption of care visit) through the last visit of the episode.

Warning: Don't count through the last day of the episode, since the calculation applies only through the last visit, Little points out.

6) Multiply that number of days by the post-SCIC per day amount.

7) Add the sums from the first and second SCIC segments.

8) Compare that sum with the total episode payment you would receive if you didn't file a SCIC. If the pre-SCIC episode payment is larger than the two SCIC segments added together, do not file the SCIC.