Sunday, June 26, 2011

NAHC Survey for Physicians: Spread the Word

By Nick Dobrzelecki RN, BSN
Daymarck CEO

Beginning April 1 2011, Medicare homecare patients are required to have a documented face-to-face encounter with either a physician or a non-physician provider. This encounter can either occur 90 days prior to the start of the homecare encounter or within 30 days after the start of care. But the encounter has to be related to why they need homecare services.

This documentation has been a huge challenge for homecare agencies across the country. Agencies are already seeing a decrease in referrals and patients that would benefit from homecare are not able to access the care because of the burden of the regulation.

The reasons for this challenge to homecare agencies include: 
  1. The documentation from the providers have to be in their words. Agencies can create forms, however, they are not to use pre-populated fields such as check boxes. This is especially challenging when the provider has to document why the patient is homebound. The vast majority of providers do not understand the CMS definition and the significant importance that CMS puts on the homecare agency to document this. 
  2. Many providers are already faced with additional requirements and with lower reimbursement to achieve them. Agencies are getting significant push back from providers to complete these forms. Providers are asking for the agency to complete the form so that the provider can just sign off. The regulation specifically does not allow this. So some providers are just refusing to complete this documentation. Agencies then have to discharge the patient from services. Regulation specifically exempts the patient from financial liability if the documentation is not complete. The agency cannot bill for any services provided.
The National Association for Home Care (NAHC) has been working to get this regulation modified and they need your assistance. They are collecting statistics and feedback from providers. Will you help by taking the survey or passing it along to a physician group?

Please spread the word and ask physicians to fill out this quick yet important survey from NAHC. If you would like a hard copy, please email me at

Thanks in advance for your help.

Thursday, June 16, 2011

Post-Acute Providers That Pay to Participate in Discharge Planning Systems Likely Violate the Anti-Kickback Statute

By Elizabeth E. Hogue, Esq.
Office:  877-871-4062
Fax:  877-871-9739

On May 20, 2011, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion 11-06.  This Opinion makes it clear that post-acute providers that pay hospitals to participate in e-discharge planning systems likely violate the federal anti-kickback statute.  Hospitals utilizing such systems that require post-acute providers to “pay to play” also likely violate the federal anti-kickback statute.

Specifically, the OIG considered use of e-discharge planning systems by hospitals that are often encountered by post-acute providers.  In many instances, post acute providers are required to pay fees in order to receive referrals electronically through systems implemented by hospitals.  Providers who do not pay required fees receive notice of possible referrals via fax.  Consequently, post-acute providers who elect not to pay to participate in electronic discharge planning systems are significantly disadvantaged and may be effectively eliminated from any chance of receiving referrals because they are unable to communicate in a timely manner with hospital discharge planners regarding referrals.

Based upon the above, the OIG concluded that such arrangements likely violate the federal anti-kickback statute.  The OIG said that companies that provide e-discharge systems to hospitals would be soliciting and accepting, and post-acute providers would be paying remuneration in return for, the arranging for the furnishing of post-acute care services by e-discharge planning companies of post-acute services for which payments would be made by federal health care programs.

The OIG went on to say that such arrangements do not qualify for protection under applicable safe harbors, including the safe harbor for referral services. 

The OIG then considered whether such arrangements constitute minimal risk under the anti-kickback statute. 

First, the OIG noted that hospitals often discharge patients to post-acute providers on a first-come, first-served basis, which means that post-acute providers with the ability to electronically receive and respond to referral requests through e-discharge systems have a significant competitive advantage over non-payment providers.  In fact, according to the OIG, non-paying providers may effectively be eliminated from any chance of receiving patients when hospitals use e-discharge systems.  Providers that pay fees to companies that provide e-discharge systems would, therefore, be more likely to get patients because they paid for the opportunity; not because they provide superior care.

The OIG also emphasized that the costs incurred to fax referrals to post-acute providers that elect not to pay fees to participate in e-discharge planning systems would exceed the costs to transmit referrals electronically.  Hospitals that fax referrals to non-paying post-acute providers provide paying providers with a competitive advantage in obtaining referrals or, conversely, penalize providers that do not pay.

Finally, the OIG acknowledged that some post-acute providers cannot afford to pay to participate in e-discharge systems in order to remain competitive.  Such providers, therefore, risk substantial loss of business.  Providers that pay to participate in e-discharge systems probably face pressure to recoup the costs associated with participation.  These pressures could create incentives to, among other things, prolong patient stays; provide separately billable, unnecessary services; or upcode.  All of these activities could result in increased costs to federal health care programs. 

For all of the above reasons, the OIG said that the use of e-discharge planning systems by hospitals that require post-acute providers to pay to participate are not protected from enforcement action under the federal anti-kickback statute.  Hospitals and post-acute providers are now clearly on notice regarding continued use and participation in such systems.  Hospitals may, of course, continue to use e-discharge systems so long as post-acute providers participate without paying to do so.  Post-acute providers currently participating in e-discharge planning systems for which they have paid or are paying fees to participate should discontinue payments immediately. 

© 2011 Elizabeth E. Hogue, Esq.  All rights reserved. 

Monday, June 6, 2011

Join us in San Diego for the 17th Annual NAHC Financial Management: July 13-15, 2011

By Nick Dobrzelecki RN, BSN
Daymarck CEO

We are thrilled to be exhibitors at this year’s National Association for Homecare & Hospice (NAHC) annual financial management conference in San Diego, CA, July 13-15, 2011. The conference provides financial management techniques and strategies to achieve success in the home care and hospice industry. Daymarck’s goal in exhibiting is to help attendees improve their bottom line by making home healthcare coding as pain-free as possible.

At last year’s conference, I met with hundreds of home healthcare senior management executives and other administration professionals. No matter who I talked to, the same concerns echoed throughout the event – folks are worried about how their organizations will adapt to the potentially turbulent changes in the regulatory environment with the transition to ICD-10. At Daymarck, we know it is harder and harder to stay profitable  - and that is where we can help. Our team of expert, certified coders stays up-to-date on ALL regulatory changes – including ICD-10- providing our clients with the confidence that we will deliver for you.

We will be at NAHC Financial again this year – and, in fact, are hosting the opening reception – and look forward to talking to each of you about how using a professional coding team can save your organization money. Daymarck will also release a case study at NAHC detailing how home healthcare agencies can be more efficient – allowing you to focus on what you do best – patient care and safety. 

I look forward to those conversations and seeing you at the opening reception.