ICD-10 Creates Need for Coding Specialists

According to Government Health IT, a recent survey by the professional staffing firm TekSystems found that staffing topped the list of ICD-10 challenges.

Teksystems’ survey respondents, in fact, “overwhelmingly ranked” four jobs that will be most in-demand leading up to and beyond the October 1, 2013 ICD-10 compliance deadline.

1. ICD-10 project managers
2. Data architects
3. Software developers
4. ICD-10 coding specialists

The changeover to ICD-10 in 2013 will, not surprisingly, demand new skills for many employees.  And for some agencies, it might mean hiring new staff or finding a partner that understands the new regulations. Here at Daymarck, our coders stay up-to-date on all the changes in regulations, including ICD-10.

If you have questions about ICD-10 or wonder if you are prepared, please contact us. We make home care coding as pain-free as possible. 

Home Care, Hospice Community Urged to Ramp Up Grassroots Campaign

Participate in Action To Protect Home Care and Hospice!

The summer recess for the House of Representatives and Senate runs through September 7. When Congress returns it will seek to follow up on the recent debt limit legislation (NAHC Report Aug. 3, 2011) with further efforts to reduce the deficit as well as offsetting the cost of fixing the flawed Medicare physician payment formula.

Since the Deficit Commission, the Medicare Payment Advisory Commission, and the Congressional Budget Office have suggested home health and hospice payment cuts and copays for deficit reduction and/or offsetting the cost of the physician payment fix, the home care and hospice community will have to ramp up its efforts during the recess and beyond to protect the home health and hospice benefits from payment cuts and copays.

Home care and hospice advocates may also wish to raise other important issues over the recess, such as:

• preserving federal funding for Medicaid; providing a fairer, more transparent process for evaluating case mix changes (The Home Health Care Access Protection Act (S.659)); 
• reforming the home health face-to-face physician encounter requirement; allowing nurse practitioners and physician assistants to sign home health plans of care (The Home Health Care Planning Improvement Act (H.R.2267; S.227));
• providing incentives for tele-homecare (The Fostering Independence through Technology Act (S.501));
• reforming the hospice face-to-face requirement and establishing hospice payment demonstration program (Hospice Evaluation and Legitimate Payment Act (S.722)); and 
• preserving the companionship services exemption from overtime under the Fair Labor Standards Act.

Sample letters and talking points for all these issues will be on the NAHC Legislative Action Network website.

During the recess, NAHC is urging its members and their friends, family, and co-workers to speak out as loudly and forcefully as possible. This is also a good time to thank those members of Congress who have taken a stand against home health and hospice payment cuts and copays. To help accomplish this, NAHC is embarking on a series of action alerts in NAHC Report during the congressional recess. We will focus on a different way you can make your voice heard.

Following are suggested grassroots action steps we plan to cover in more detail in upcoming issues of NAHC Report:

• Attend a town hall meeting held by your members of Congress. 
• Schedule face-to-face meetings with your members of Congress. 
• Invite a member of Congress out on a home care visit -- get the media to come along if possible.
• Attend a candidate fundraiser for a member of Congress and speak with him or her personally. 
• Submit a letter to the editor or op-ed piece to the local newspaper. 
• Call in to a talk radio station and initiate dialogue on home care and hospice. 
• Use online social networks such as Twitter and Facebook to discuss home care and hospice concerns.
• Contact your state's governor and ask for support for home care and hospice. 
• Send a message to all employees of your organization asking them to get involved and to write messages to members of Congress through the NAHC Legislative Action Network (NAHC LAN).
• Send a message to all board members of your home health agency or hospice asking them to get involved and to write messages to members of Congress through the NAHC LAN. 
• Send a message to your past and current patients explaining the threatened cuts to home care and hospice and ask that they contact Congress through the NAHC LAN. 
• Send a message to physicians who care for your patients asking them to get involved and to write messages to members of Congress through the NAHC LAN. 
• Contact community groups such as local AARP chapters, senior citizen centers, and disease support groups explaining threatened home care and hospice cuts and copays and ask that they send messages to Congress for support of home care and hospice through the NAHC LAN. 
• Contact religious groups explaining threatened home care and hospice cuts and ask that they send messages to Congress through the NAHC LAN. 
• Contact health care officials such as hospital administrators and explain threatened home care and hospice cuts and copays, asking them to send a message to Congress through the NAHC LAN.
• Spread the word on using the NAHC LAN to help fight home care and hospice cuts and copays through a message to your email contacts urging them to send to at least 10 more individuals.
• Invite your representative to join the House Home Health Caucus. 

WHAT TO DO TODAY
For today's suggested grassroots action step:

1. Plan to attend a congressional town hall meeting.
2. Go to your Congress member’s website to see if his/her recess schedule is published. If a schedule isn’t published on the website, call his or her local office and inquire as to when the lawmaker(s) will be making public appearances. Review NAHC's talking points/issue briefs on the NAHC Legislative Action Network. Bring as many home care advocates with you as you can get. 
3. Speak out at a town hall meeting about the importance of preserving access to home care and hospice and urge your representative and senators to oppose home care and hospice cuts and copays.

Marketing Representatives of Post-Acute Providers Must Receive Training Regarding Appropriate Activities

By  Elizabeth E. Hogue, Esq.
 
The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, recently announced that “patient recruiters,” or marketing representatives, had been convicted of fraud and were on their way to jail.  On July 12, 2011, for example, the OIG announced that a marketing representative in the Detroit area was sentenced to twenty-seven months of jail time and required to pay restitution in the whopping amount of $10,765,325.  In another case announced on July 21, 2011, a marketing representative pleaded guilty to Medicare fraud and is awaiting sentencing. 

These two recent cases bring home once again the importance of making sure that marketing representatives of home health agencies, hospices, HME companies, and private duty companies understand what is legal and what is not with regard to getting referrals.

The stakes are extremely high.  Court decisions and a federal statute make it clear that billing for referrals that were obtained in impermissible ways are false claims.  That is, if marketing representatives use inappropriate means to get referrals and post-acute providers bill for services provided to such patients, then the claims submitted are false claims.  The penalties for submissions of false claims may include:

•  Fines or civil money penalties that are three times the amount of the claims involved;         
• Jail time; and
• Suspension or exclusion from participation in the Medicare, Medicaid, and other state and federal health care programs. 

What if owners did not know what the marketing representatives were doing?  Providers need to know that court decisions say that enforcers may conclude that providers had intent if they can prove that providers knew or should have known of a pattern of fraudulent conduct.  This means that managers of post-acute providers must remain vigilant and constantly monitor the activities of marketing representatives to be sure that they don’t cross the line.

 From a practical point of view, providers should take the following actions:

• Develop and implement a policy and procedure that says that marketing representatives may not engage in new types of marketing activities without the advance written permission of appropriate managers.
• Provide initial and periodic training to marketing representatives regarding regulation of marketing  practices, including, at a minimum:
• The Federal anti-kickback statutes;
• The Federal False Claims Act;
• The so-called “Stark laws” and regulations; and   
• Any applicable state statutes.

There are few checks on marketing representatives’ activities, especially when, as a result of their efforts, they receive incentives based on the number of admitted patients referred.  Management is responsible for the oversight of these activities.  The possible consequences described above make the necessity of vigilance quite clear.

(To obtain an 80-minute video that can be used to train marketing representatives, please send a check made out to Elizabeth E. Hogue in the amount of $105.00 that includes shipping and handling to: Fulfillment, 107 Guilford, Summerville, SC 29483.)

© 2011 Elizabeth E. Hogue, Esq.  All rights reserved.
 No portion of this material may be reproduced in any form without the advance written permission of the author.

Daymarck Update: August 2011

By Daymarck CEO Nick Dobrzelecki

It has been a busy and exciting last few months for Daymarck. In July, we were proud to be Gold Sponsors at the17th Annual NAHC Financial Management Conference in San Diego, CA. During the three days there, including the Daymarck-sponsored opening reception, we met hundreds of financial executives in the home care industry and shared the Daymarck story.

Trade shows are a great opportunity for us to meet face-to-face with decision makers in the industry from big and small agencies, staff folks who do the front-line work, and other service providers. We heard about the uncertainty many organizations feel about the transition to ICD-10 in 2013 and the concerns about Congressional action against the home health industry. However, the feeling at the conference was not one of doom and gloom – but one of opportunity.

One of the many things that I enjoy about the NAHC Financial Management Conference is the level of engagement and passion attendees have about home health care. It is more than a job. Together, we can make a difference in the quality of life for all Americans.

As we enter August, we are planning our presence at NAHC’s 30th Annual Meeting & Exposition, Oct. 1-5, 2011, in Las Vegas, NV. The theme for this year is “Leading the Last Great Civil Rights Battle: Maximizing Opportunity, Minimizing Risk.”  We hope to see you there.

In the midst of event planning and strategic thinking, we are, of course, focused on what we do best – making home care coding as pain-free as possible. Enjoy the rest of your summer!

VP of Marketing George Rafeedie, NAHC Chair Andrea Devoti, and Daymarck CEO Nick Dobrzelecki.