The homebound verification process starts with good intake procedures. Auditors are taking a magnifying glass to home health agency patients' homebound status, but you can retain your rightful Medicare reimbursement if you know the ropes. Audits of HHA claims are on the rise from Zone Program Integrity Contractors, intermediaries, the HHS Office of Inspector General, and other authorities. And the homebound issue is often an easy target that denies an entire claim, or series of claims. First: To shore up your homebound defensibility, you must examine your referrals to make sure patients really are homebound before you admit them. Ask yourself these key questions, TAG Marketing suggests in its homebound criteria flowchart -- Does the patient: leave home frequently for non-medical purposes? require assistance when leaving the home? require considerable and taxing effort when leaving the home? have a skilled nursing or therapy need? If the answer to any of these questions is "no," stop the referral, says the TAG worksheet, which is designed for agencies to share with referring physicians. If the patient is indeed homebound, then you need to focus on your documentation of that fact, experts agree. "Document, document, document," says consultant Sharon Litwin with 5 Star Con-sultants in Ballwin, Mo. "If we focus on the definitions and document to support them, the risk would go down," says consultant and therapist Cindy Krafft with Fazzi Associates. Follow these tips from the experts to improve your homebound documentation: Regarding absences, the core issues are "infrequent," "short duration," and "taxing effort," Krafft adds. Plus: Don't get distracted with what-if scenarios. "Focus on the homebound status definition as is and not recent examples," Krafft advises. And be "very, very descriptive of the patient's homebound status," urges consultant Pam Warmack with Clinic Connections in Ruston, La. "The physical or mental/emotional disability which renders the patient homebound should be described in relation to a current illness or injury and validated with a diagnosis." Bottom line: Medicare expects the home care clinician to document "how the patient's illness or injury prevents them from leaving home without a considerable and taxing effort," concludes Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. Ask patients how often they leave home, for what purposes, and who provides transportation, Warmack recommends. When the patients leave for nonmedical purposes, describe how long patients could tolerate being away from their homes and how frequently these absences occurred, she says. "The patient can leave home for medical care and to go to church or occasionally to go to the hairdresser," Adams allows. "However, there still is a need to document what type of effort it requires to leave home." Every time: When you document homebound status, you should always "include information on how frequently the patient leaves home and what type of assistance and effort it takes to leave home," Adams adds. "Homebound status should be clearly established at least at every assessment time point," Adams maintains. "I urge clinicians to document the patient's homebound status often -- perhaps even every visit -- in specific and descriptive terms," Zuber tells Eli. And: It's not a bad idea to include Medicare's definition of homebound right there in the chart, Berliner tells Eli. It can help prompt your clinicians to document comprehensively and help auditors and surveyors remember what they are looking for, she says. "I think there are ... some denials going on because the review contractors really don't understand what homebound means, and so their interpretation can be too strict," Zuber says. "However, agencies' failure to provide more objective and descriptive documentation makes this possible." You can input late entries when necessary, as long as they follow late entry guidelines such as identifying and dating the late entry. Remember: If your documentation comes under scrutiny by auditors or authorities, late entries will be questioned closely, legal experts note. Note: TAG Marketing's homebound flow chart is at www.yourreferralconnection.com/download/TAG_PhysKit_Homebound.pdf.