Home Health & Hospice Week

Documentation can make or break your reimbursement. 

When you accept patients transferring from another home health agency during their 60-day episodes, you could be left holding the bag if you don't follow some crucial steps.

When the patient's transfer is disputed, the agency accepting the patient has the burden of proof under Medicare rules. If the required documentation isn't provided, "it could result in the loss of Medicare payment to your HHA for the episode(s) in controversy," regional home health intermediary Cahaba GBA warns in its March bulletin to providers.

To protect transfer reimbursement, Cahaba instructs agencies to follow these steps:

1. Check HIQH/HIQA. You can see whether patients are in an open home health episode by checking page 3 of HIQH, Cahaba advises. Under the "PATIENT STAT IND" column, an "01" indicates the patient is discharged. A "30" shows the patient is still with an agency.

"The admitting HHA should still contact the former HHA to verify the patient has been discharged," Cahaba adds.

2. Print and file. To preserve your payment rights, you should print a copy of the page 3 HIQH screen and file it, Cahaba says.

Another option: Checking and printing the screens for every single patient admitted may be too much work for some agencies, judges Patrick Canole with the Home Care Association of New York State. They may want to use other research methods, like speaking with patients and their families, to identify which patients are at risk of transfer disputes, and then document those cases only.

But most HHAs Pat Sevast works with already are checking the CWF upon admission to establish the patient's eligibility status, notes the American Express Tax & Business Services consultant. And HHAs should be scrutinizing page 3 closely to discern prior hospital, skilled nursing facility and rehab stay information for the hot-button OASIS item M0175, adds consultant Aaron Little with BKD in Springfield, MO.

Since they are looking at the screen anyway, printing it up and filing it may not be too much extra work to ward off transfer billing problems.

3. Inform the patient -- and document. When you accept a transfer patient, you must explain to the patient "that the initial HHA will no longer receive Medicare payment on behalf of the patient and will no longer provide Medicare covered services to the patient after the date of the patient's elected transfer," Cahaba explains.

Just as importantly, you must document that explanation by obtaining a signed and dated consent form from the patient, the RHHI instructs.

4. Make contact. Finally, you must contact the agency from which the patient is transferring to inform it of the move. And you must document the call, including a name and phone number of the person you contacted, Cahaba says.

"Medicare payment will be jeopardized if you fail to document the HIQH screen, the call to the former HHA, and to obtain a signed and dated patient consent form," Cahaba warns.

Editor's Note: Cahaba's article is at www.iamedicare.com/Provider/newsroom/newslines/030104.pdf.