Daymarck Remote Home Care Medical Coding

Are your vendors prepared for ICD-10?

2012-01-10T10:00:00.000-06:00

Are your vendors prepared for ICD-10?

This question may be on your mind lately, which is a good thing. Making sure your vendors are prepared for ICD-10 is crucial and should be as soon as possible.

Unfortunately, many home care professionals can’t say that their vendors are prepared and ready for ICD-10. When we asked this question during our ICD-10 survey at the 2011 NAHC Annual Show, nearly half (46%) said “no” or “not sure” if their vendors are prepared.

We need to get this number way down. Talking to your vendors is one of the first things you should do in your ICD-10 planning to make for a smooth transition.

When you ask your vendors (point of care, EHR, billing, etc.) what they are doing to prepare, they should be able to tell you their clear plan leading up to implementation and how they will support you during the transition. If they cannot, you may want to consider an alternative vendor.

CMS has provided more detail on what specifics you should discuss with your vendors here.

And check out our helpful list of 9 other things you should be doing now to make for smooth transition.

Defining Homebound

2012-01-03T11:56:00.001-06:00

With many conflicting ideas, interpretations, and vague guidance, determining if a patient is homebound can often be challenging.

Some will automatically assume a patient is not homebound if they hear they drove or left the house. But this isn’t necessarily true. A December 2010 survey we conducted to test home care professionals knowledge of homebound confirmed this notion. We found many people jumped to the conclusion that a patient was not homebound if they left the house for any reason or drove.

Home care professionals are doing patients a disservice by not knowing the proper homebound definition. With a clearer understanding of what it is, patients can get the care they really need.

We shared Medicare’s specific homebound definition previously on our blog here. In summary, just because a patient leaves the house, or even drives, it does not mean they are not homebound. For one, any excursions related to medical appointments or religious activities cannot be taken in consideration to a patient’s homebound status. Also, it says that a person is homebound if leaving “requires a considerable and taxing effort.” So perhaps they did drive to the grocery store, but if it took them 30 minutes to get into the car and needed the assistance of a friend or relative, they may be homebound.

The problem arises is how do you prove a “considerable and taxing effort”? The answer is documentation. Instead of saying it was difficult for a patient to get around the house, you can be more specific and say the patient was “unable to ambulate more than 100 feet without having to rest.” Its all opinions until you give quantities and specifics and even then you may still have a patient who is on the fence because there are not specific guidelines on what physical limitations qualify someone homebound There will be some judgment calls. But with documentation which quantifies the physical or sometimes mental limitations you then have proper documentation to back it up your decision.

Understanding homebound status will not only help us provide better care for in-need patients, but it will also save money in the long run. For example, if a patient is disqualified from homebound status, then they must leave the house frequently to receive all care and/or they miss critical appointments, which can cause them to take a downturn and end up in a hospital or nursing home. This would be much more expensive than if they got their care in the home and were able to heal there.

If you still have questions about homebound status, please contact us at nick [at] daymarck.com.

‘Tis the Season! Help us give to the Caring Institute.

2011-12-20T09:19:00.000-06:00

Happy Holidays!

Daymarck is celebrating this holiday season by donating $1 to the Caring Institute for every new Facebook fan or Twitter follower. With a simple click of your mouse you can stay connected with Daymarck in the new year and spread the spirit of giving by supporting this nonprofit’s cause. What a win-win!

To help us donate to the Caring Institute:

Like us on Facebook and while you’re there take a moment to tell us what you think about Daymarck.
Follow us on Twitter where we are updating you about industry issues like ICD-10 conversation daily.

Stay connected with us and help us to support the Caring Institute today.

Happy Holidays!

About the Caring Institute

The Caring Institute is a nonprofit 501(c)(3) organization founded in 1985 to honor and promote the values of caring, integrity, and public service. Inspired by the example of Mother Teresa, the institute believes most problems can be solved if human beings truly care for one another. We celebrate those special individuals who transcend self and devote their lives to serving the disadvantaged, poor, disabled, and dying. Their enduring dedication to caring uplifts us all and ennobles the human race.

Join our team! 16 Positions Available

2011-12-15T16:04:00.001-06:00

We are experiencing rapid growth here at Daymarck, and are seeking talented professionals to join our team. We have 16 full-time job openings, most of which are work from home, in the following positions:

Medical Coder (8 FT positions available)

Job Description Abstracts clinical information from a variety of medical records, charts and documents and assigns and sequences appropriate ICD-9-CM diagnosis to provide recommendations to customers based on their supplied documentation. Audits medical records to ensure compliance with the customer's coding procedures and standards. Relies on limited experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under general supervision from home. A certain degree of creativity and latitude is required. Reports to Coding Manager.

Requirements Requires HCS-D certification and COS-C is preferred. Two years experience in coding and/or working in homecare setting preferred. Familiar with standard concepts, practices, and procedures within a particular field.

Coding Compliance Specialist (4 FT positions available)

Job Description Audits medical records to ensure compliance with the customer’s coding procedures and standards. May require reviewing insurance payments and denials and providing recommends for documentation corrections. May require training customer’s staff members on proper coding and OASIS documentation processes. Familiar with standard concepts, practices, and procedures within a particular field. Relies on limited experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under general supervision from home. A certain degree of creativity and latitude is required. Reports to Coding Manager.

Requirements Requires HCS-D and COS-C certification. Four years experience in coding or medical records preferred.

Health Information Services Director (1 FT position available)

Job Description Directs and oversees all policies and procedures related to healthcare information management. Responsible for ensuring accuracy and efficiency in the medical records and transcription departments. Reviews processes and identifies areas for improvement taking into account user needs. May act as liaison between information services and technology department, ensuring that systems are accessible and in accordance with the needs of the organization. Ensures that all record keeping and information disbursement complies with HIPAA regulations. Familiar with a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. Performs a variety of complex tasks. Leads and directs the work of others. A wide degree of creativity and latitude is required. Reports to top management.

Requirements Requires a bachelor's degree in area of specialty and at least 10 years of experience in the field or in a related area.

Receptionist/Data Entry Clerk (1 FT position available)

Job Description Looking for an outgoing individual that possesses excellent customer service skills and is detail oriented. Interpersonal skills and professional appearance a must. Responsible for general receptionist duties such as greeting customers, answering phone, routing calls, filing, data entry etc.

Requirements Requires a high school diploma or its equivalent with preferred experience in the field or a related area. Previous healthcare experience preferred but not required. Alphanumeric Data Entry and Excel 2010 tests required to apply and available through Job Service.

Health Information Management Clerk (1 FT position available)

Job Description Looking for a self-motivated individual that is detail-oriented. Excellent computer skills a must. Responsible for various data entry tasks including organizing and evaluating patient medical records and reviewing medical records for accuracy and completeness. Reviews and maintains orders, invoices and records to ensure accuracy. Has knowledge of commonly-used concepts, practices, and procedures within the healthcare field.

Requirements Requires a high school diploma or its equivalent. Alphanumeric Data Entry and Excel 2010 tests required to apply and available through Job Service.

Coding Manager (1 FT position available)

Job Description Supervises Medical Coders and Coding Compliance Specialist and trains employees to ensure that the customers receive appropriate reimbursement and conforms to applicable guidelines and regulations. Ensures the accuracy and timeliness of the coding process. Direct liaison between customers and medical coders. Familiar with a variety of the field's concepts, practices, and procedures. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. Leads and directs the work of others. A wide degree of creativity and latitude is expected. Reports to top management.

Requirements Requires HCS-D certification and COS-C is preferred. Knowledge in ICD-9 and OASIS conventions. At least 4 years of experience in a related field.

Send all resumes to HR@Daymarck.com. Thanks and we look forward to hearing from you!

How will ICD-10 affect productivity?

2011-12-15T09:07:00.000-06:00

We’re back with more insights gleaned from our ICD-10 survey administered around the 2011 NAHC Annual Show.

Daymarck's Carie Wright (right)
surveying a home care professional
at NAHC 2011 in October.

One of our survey questions asked if you thought ICD-10 conversion would cause a decrease in productivity. 57% answered yes. And the average response of how long this decrease would last was 7 months.

The impact on productivity is one of, if not THE, biggest challenge of ICD-10 conversion. While there will be an initial learning curve and a need for a culture change that requires more specificity and communication, the impact on productivity can be minimized with proper planning and preparedness.

Agencies that have prepared for conversion well in advance should actually see a minimal impact on productivity. If an agency waits to the last minute however, this decrease can last even more than 7 months.

To help make sure you have a smooth transition with little impact on productivity, we’ve developed a helpful list of 10 things you should be doing now to prepare.

Daymarck Will Be At Home Care 100 In February

2011-12-13T14:09:00.000-06:00

We are proud to announce we will be attending the 10^th annual Home Care 100 Executive Management Conference as executive level partners of the four-day event. The conference, which will take place in Orlando, Fla. from Feb. 4-7, 2012, is an invitation-only gathering of leading home health care and hospice executives from across the country.

As a growing medical coding company, we are excited to join together with some of the top minds in home care to learn from one another and to discuss the future of the industry. We are also ready to embark on what we hope will be, a long-lasting relationship with Home Care 100.

This year the conference’s educational program is designed to explore innovative ways to improve patient care, strategize a plan to remain successful in this tough economy, and talk about topics we at Daymarck work to address on a daily basis – how to prepare for upcoming changes, such as ICD-10.

Be sure to check back for updates during and after the conference. Follow us on Facebook, Twitter and YouTube to stay up to date.

Congratulations to Home Care's Elite

2011-12-06T12:08:00.000-06:00

This year's HomeCare Elite™, an annual list of the most successful home care providers in the country, was recently announced.

The Daymarck team would like to congratulate the many agencies who were recognized this year, many of which are Daymarck customers. In fact, we're proud to have worked with 24 of these leading agencies over the past year:

ABBOTT HOME CARE, INC	COAL GROVE	OH
ABLE HOME HEALTH, LLC	ROCKFORD	IL
ACCENTCARE HOME HEALTH OF CALIFORNIA, INC	FOSTER CITY	CA
BG HOME HEALTH PROVIDERS, LLC	BUFFALO GROVE	IL
CARE AT HOME	PAYETTE	ID
COMMUNITY HOME HEALTH INC	SANTA BARBARA	CA
FORUM HEALTH CARE	NORTHBROOK	IL
GIRLING HEALTH CARE	OELWEIN	IA
GIRLING HEALTH CARE	DEWITT	IA
GIRLING HEALTH CARE	CHAPMANVILLE	WV
GIRLING HEALTH CARE INC	CLEARWATER	FL
GIRLING HEALTH CARE INC	NORTH RIVERSIDE	IL
GIRLING HEALTH CARE INC	EASTLAND	TX
GIRLING HEALTH CARE INC	FORT WORTH	TX
GIRLING HEALTH CARE, INC	OKLAHOMA CITY	OK
HARRISON HOME HEALTH	BREMERTON	WA
HEALTHCONNECT AT HOME	LINCOLN	NE
HERITAGE HEALTH CARE SERVICES	INDEPENDENCE	OH
HUDSON VALLEY HOME CARE CHHA	POUGHKEEPSIE	NY
JAMESTOWN HOSP HOME HEALTH AGENCY	JAMESTOWN	ND
KETTERING NETWORK HOME CARE	DAYTON	OH
PREMIER HOME HEALTH INC	THAYNE	WY
REVOLUTIONARY HOME HEALTH SVC, LLC	ALLENTOWN	PA
UNC HOME HEALTH	CHAPEL HILL	NC

These agencies represent the top 25% in quality of care, process measure implementation and financial performance. That is no small achievement!
You can find the full list of 2011's HomeCare Elite list here.

ICD-10 versus OASIS-C: Culture Change versus Process Change

2011-12-01T07:59:00.001-06:00

When we asked home care professionals if they thought ICD-10 conversion would be more problematic than OASIS-C conversion in our latest survey, 58 percent answered yes. In fact, 25 percent said ICD-10 conversion would be extremely more problematic than OASIS-C.

We wholeheartedly agree and here’s why:

Conversion to OASIS-C was a process change in which clinicians had to learn a new set of standardized questions. ICD-10 on the other hand will require a culture change— one where clinicians must increase their written, narrative descriptions when assessing a patient. It’s not a matter of what box do I check, but completely changing the way they document.

Currently, some agencies do great narrative summaries. These agencies will have less of a culture change, but will still need to change terminology and some focuses. Many agencies, however, do a poor job at documenting. They may not see the need for it and want to focus their time on the patients, not paperwork. These agencies will have the most difficult time, as they will need to learn to document more, spend more time and effort writing narratives, be more specific and use the right terminology.

Overall, ICD-10 will require much more training for all parties, and a lot further in advance than OASIS-C. It will cause a decrease in productivity, even for the most trained agencies, as they become more vigilant to make sure they are doing everything correctly.

While you can’t totally avert all the problems associated with ICD-10, with proper preparation, you can significantly offset them. With OASIS-C, many did no training whatsoever until just a couple months before. This can’t be done when instituting a cultural change. With proper planning and training, and by addressing any current documentation issues beforehand, you can tailor your ICD-10 training to address these issues so they don’t become a much larger problem after conversion.

To learn more about what you can do right now to prepare for ICD-10 conversion go to: 10 Things You Should Be Doing Right Now to Prepare for ICD-10.

10 Things You Should Be Doing Now to Prepare for ICD-10

2011-11-28T15:59:00.005-06:00

As a remote coding agency focused on home care, we know and understand the importance of ICD-10 and its specific implications for home care agencies. We’ve been thinking about it since 2007. In fact, it was one of our reasons for starting Daymarck. Implementation may not be until October 2013, but home care agencies need to develop a plan now to make sure they are fully prepared.

Here are 10 things that you should be doing right now:

1) Start talking to all your vendors (point of care, EHR, billing, etc.) to see what they are doing to prepare. They should be able to tell you their clear plan leading up to implementation.

2) Take a look at any planned provider or system changes and decide if you should do them before, during or after ICD-10 implementation. Ask yourself how this change will be impacted by ICD-10.

3) Identify your current coding work flow (who is doing how many codes) and what impact ICD-10 will have on it. Then decide what your new workflow process will be.

4) Decide how you will train your staff on ICD-10. Will it be in-house or external? If you are a Daymarck customer, our training resources will be available to you so you don’t have to worry about this.

5) Take a hard look at your personnel and determine if they are up to the challenge. This may mean you will need to hire new people or use an outside partner. Make sure your staff is committed to the change and not just doing it to keep their jobs.

6) To ensure people are committed to the transition, communicate and start conversations about ICD-10 and its benefits and impact with your staff. Communicating with clinicians should be a very strong focus, as many are not up to speed on the necessity and reasoning for the change to ICD-10.

7) Determine how ICD-10 will impact your budget. Budget constraints can include decreased productivity, training costs, and longer time getting Request for Anticipated Payments (RAPs) out meaning decreased cash flow. For smaller agencies with limited cash flow, delays in getting RAPs out can be detrimental.

8) Cultivate the relationship between coders and clinicians as ICD-10 will force them to work more closely together. Good relationship and communication between these two groups will help overcome decreased productivity. While these two groups may have different goals, encourage them to think of the big picture.

9) Decide how you will overcome a decrease in productivity. Our recent survey showed the average decrease will last 7 months. With decreased productivity and the same staff, you will either get less assessments out per day or force personnel to work longer hours which can lead to burnout. Have a plan to make sure both your staff is taken care of and your assessments are getting done.

10)Take a deep breath. It may seem overwhelming now, but with proper planning and communication, we’ll get through it together. And when it’s all said and done it will be great for the industry.

Help Home Care Help Healthcare

We hope this helps as you and your organization think about conversion to ICD-10. As a leader in the home care industry, we are dedicated to helping make home care a big part of the answer in solving our country’s healthcare challenges. This monumental shift to ICD-10 is a big step to improving our operations as an industry and will improve the level of care that this nation needs.

ICD-10 Survey

Please visit the results of our ICD-10 survey administered during the National Association for Home Care and Hospice Show in October 2011. It should give you more insight into the challenges and opportunities as we transition as an industry to ICD-10. Go to http://www.daymarck.com/icd10/.

Myth Dispelled: ObamaCare ≠ ICD-10

2011-11-22T14:01:00.000-06:00

A recent Forbes article sheds even more light on a widespread ICD-10 myth: That ICD-10 is a product of "ObamaCare."

Although this is a common misperception, ICD-10 and Health Care reform (aka “ObamaCare”) are completely unrelated. ICD-10 conversion was decided upon by the Bush Administration in 2008. President Bush then granted a 2-year delay on implentation in his final days in office, delaying it from October 2011 to October 2013.

How common is this misunderstanding? We asked home care professionals if they thought the two were related in our ICD-10 survey at the 2011 National Association of Home Care and Hospice Annual Convention. Here's what they said:

Nearly a third (32 percent) answered yes that Health Care reform and ICD-10 were related.
Another 29 percent said they were unsure.
The remaining 39 percent answered correctly, that the two were unrelated.

So what does this misconception mean for home care? That people are not well informed on the reasons for and long history behind ICD-10. Without this knowledge, home care professionals may not take conversion seriously resulting in lack of preparation and decreased productivity.

Knowledge is power. So start having conversations at your agency about this myth and the reasons for ICD-10.

For more results of our ICD-10 survey go to: http://daymarck.blogspot.com/2011/11/icd-survey-results-are-in.html

Response to American Medical Association’s Opposition to ICD-10 Implementation

2011-11-16T17:00:00.004-06:00

On November 15, 2011, the American Medical Association’s (AMA) House of Delegates voted to vigorously stop the implementation of ICD-10.

AMA president, Peter W. Carmel said, "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care. At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients."

While we agree the transition to ICD-10 codes will be a major undertaking and result in added costs up front, our stance is that ICD-10 transition is both beneficial to the healthcare arena and long awaited. AMA stance that they are opposing this so physicians can keep their focus on the patients is not justified. While physicians have to document diagnoses for each patient encounter, this ultimately would not change the physicians focus on their patients. They rarely are responsible for the final submission of codes prior to billing. This should be the responsibility of certified medical coders to ensure accuracy.

Several studies have been conducted weighing the costs and benefits of ICD-10 conversion. A study sponsored by the National Committee on Vital and Health Statistics (NCVHS) and conducted by the RAND Corporation evaluated the cost of training, productivity loss and system changes versus the benefits of going to a “superior code” set[1]. It concluded that the benefits outweighed the costs associated. Benefits included those to providers such as more accurate payment and fewer rejected claims, as well as patient benefits including improved disease management and timelier intervention of emergent diseases, such as SARS, which cost the Asian economy more than $10 billion.

Additional reasons why transition to ICD-10 is crucial include:

· Endorsed by the World Health Organization (WHO) all the way back in 1993, ICD-10 is currently used in all other industrial countries around the world. With all countries on the same system, the WHO and Center for Disease Control (CDC) can have more accurate and consistent health records which are critical to ensure the quality of care, sound management, health financing and administration of health systems.

· Since the implementation of ICD-9 in 1979, many new diseases and diagnoses have been discovered. The current ICD-9 system of three-digit categories and no more than 10 subcategories can no longer accurately track why people seek medical treatment.

We urge the AMA to direct its attention to other pressing issues in the healthcare arena, and focus on solutions. One such issue is the current law that prohibits nurse practitioners and other advance practice providers from ordering and managing patients under home care. There are currently bills in Congress (H.R. 2267) and Senate (S. 227) to amend this law, recognizing the shortage of primary care physicians and an aging population in need of chronic care. There have been other bills introduced in the 111^th Congress. Both these bills died because they were not addressed before the end of session. The AMA has historically slowed progress of expanding the roles of nurse practitioners on both state and federal levels by consistently requesting additional studies and discussions on various NP issues. Even when there is clear evidence based data showing expansion of the advanced practice nurse roles have significant cost benefits while delivering safe patient care. A recent study by Dobson, DaVanzo & Associates shows the cost savings over 10 years to be $309.5 million dollars to the Medicare system by using nurse practitioners to order and manage home care patients.[2] AMA’s official support of this overdue legislation would help facilitate getting these bills pushed through Congress and the Senate.

The second issue in need of the AMA’s attention is opposing Medicare Advisory Commission’s (MedPAC) recommendations to add copays to Medicare home care episodes. Medicare home care service copays has been advanced in Congress as a means of deficit reduction as well as a means of limiting the growth of Medicare home health expenditures. Some Medicare Advantage (MA) plans have imposed home health copays. Copays are regressive, in-efficient and fall most heavily on the poorest and oldest Medicare beneficiaries.

The National Commission on Fiscal Responsibility and Reform (2010) recommended a uniform 20 percent copay and a uniform overall deductible of $550 for all Medicare services combined, including home health care. In January 2011 the MedPAC voted to recommend a home health copay (as much as $150 per episode) for episodes not preceded by a hospital or nursing home stay as a means to encourage beneficiaries to control utilization of care. Once again, the AMA’s strong opposition to these recommendations would have a larger impact on patient’s receiving care through proper healthcare access.

It is well accepted that ICD-10 will allow for quicker and larger medical care advancements. While the AMA may try to stop or delay ICD-10, we strongly believe it will and should be implemented. Health and Human Services (HHS) has already delayed implementation by two years to give institutions and providers additional time to prepare for this transition. We see a low probability, as well as little benefit, of it being delayed any further. AMA's opposition of ICD-10's implementation will only further delay the American healthcare industry from keeping up with the rest of the world.

[1] http://www.rand.org/pubs/technical_reports/2004/RAND_TR132.pdf

[2] http://www.congressweb.com/nahc/docfiles/20110923_Dobson.pdf

Many Clinicians Still Doing the Coding

2011-11-10T09:01:00.004-06:00

In our recent survey of home care professionals about ICD-10 conversion, we asked who at your organization was doing the medical coding. Results showed that 23 percent of home care agencies still have clinicians assigning and sequencing diagnosis.

While this number seems to be slowly declining, it is still far too high. The problem with clinicians doing coding is that their main focus should be on patient care. They are dealing with compliance issues that relate to patient care, and shouldn’t be worried about coding compliance issues as well. Clinicians are also not certified and typically receive little orientation training on how to properly assign codes. This means more room for error and potential for inaccurate payments.

Coding in the home health arena is complex. Home health care coders must gather information for coding from multiple sources, be familiar with inpatient procedure codes, late effect codes, and know how to read discharge information, rehab reports and more. Home health coders are also responsible for coding both acute and post-acute diagnoses. On top of everything a clinician is doing every day to care for patients, this can be overwhelming and detrimental to agencies.

On top of these current challenges, these clinicians will have to learn a whole set of new codes for ICD-10 conversion. Significant time and costs will need to be allocated to get these clinicians properly educated on the new system. There is also a greater chance of decreased productivity if clinicians are wearing both hats. Our ICD-10 survey revealed 57% of people thought conversion would cause a decrease in productivity, with an average decrease lasting seven months. With clinicians doing coding, this could significantly increase the length of decreased productivity.

The benefits of lifting the burden off of clinicians and hiring coders or a remote coding firm are plenty. More accurate payments. Better patient care. Improved compliance. Less burn out on employees. Peace of mind.

And with ICD-10 approaching, what better time to make the switch?

ICD-Survey: The Results Are In

2011-11-03T16:00:00.000-05:00

The results are here on the first ever ICD-10 survey dedicated to the home health community. We had more than 235 home care professionals—including clinicians, coders, and administrators from all types of organizations— give us their opinions about ICD-10 and let us know what they are doing to prepare. They responded to the survey either online or in-person at the NAHC Annual Convention between September 13- October 7, 2011.

What the survey responses revealed is that home health care professionals are unprepared for ICD-10 conversion in October 2013. 76 percent of respondents revealed they have either not begun planning for ICD-10 conversion or are in preliminary stages of planning. Just 3% said they have developed a formal plan and are beginning to implement.

Our survey also revealed 70% have not begun to train employees on ICD-10. Twenty five percent have begun to train just a few key staff members and only 2% have had mass training.

We think these results illustrate that many are either underestimating the significance of ICD-10 conversion or perhaps don’t have the necessary resources to take action. We’re at a time where it’s critical for home care organizations to be in full planning and preparing mode so they can combat the negative effects conversion will likely bring.

Other key findings of the survey include:

· 59% of respondents feel converting to ICD-10 will be more problematic than converting to OASIS-C. 55% of those respondents think it will be extremely more problematic.

· 57% of respondents feel ICD-10 will cause a decrease in productivity for both clinician and administrative staff. The average response for how long this decrease in productivity lasting was 7 months.

· 46% of respondents were either not sure or do not think their vendors are appropriately preparing for ICD-10 conversion.

The biggest challenge of conversion revealed by respondents was educating clinicians and providers on the needs for more specific documentation (46%), followed by learning and implementing ICD-10 sets (28%). The biggest benefit of ICD-10 revealed was more-accurate payment (56%), followed by improved disease management (39%).

Ken Hooper, a principal of HC Healthcare Consulting, commented on the results, saying, “These findings are not surprising nor inconsistent with hospitals, but they are worrisome because people are behind the power curve. I’d also be interested to see what respondents are considering ‘preliminary planning,’ which may only consist of reading something about ICD-10.”

Over the coming weeks, we will take a deeper dive into the results of each question, revealing the implications for the industry right here on our blog. We also plan to conduct future ICD-10 surveys to measure the progress of preparations leading up to conversion in 2013.

Thanks for everyone who participated! We hope ICD-10 conversion is as pain-free as possible for everyone. Contact us to discuss how we can help.

Call to Action: Stop Co-Pays and Across-the-Board Cuts

2011-11-01T13:55:00.000-05:00

An offer put forth by a majority of the Democrats on the Joint Select Committee on Deficit Reduction (the “supercommittee”) has caused a firestorm of criticism from many Democrats on the Hill, along with senior and disability advocates. Their $3 trillion deficit reduction blueprint includes $400 billion in Medicare savings, equally divided between provider and beneficiary cuts, and $100 billion in Medicaid savings over 10 years. This offer is a “grand bargain” with Republicans who would have to agree to match spending cuts with new tax revenues. Republicans have countered with a $2.2 trillion proposal, which reportedly would include substantial Medicare and Medicaid cuts. Republicans have not yet agreed to increase taxes, so members of the supercommittee appear to be at a stalemate. However, they may strike a deficit reduction deal by their November 23 deadline.

The Leadership Council of Aging Organizations (LCAO), a national coalition of more than 60 senior groups including NAHC that opposes increased Medicare cost shifting to seniors, is planning to conduct a briefing for Hill staff this Friday at November 4, at 11:00 AM, on the theme of Medicare and “Skin in the Game.” This refers to the often-heard comment by some on the Hill that seniors need to pay more for Medicare services so they will have more “skin in the game.” As we all know, seniors already have a lot of skin in the game, including the fact that their families and friends are already providing an estimated $450 billion in unpaid services a year to enable them to remain in their homes—costs that Medicare would have to pick up if they were in nursing homes or hospitals.

In order to stop copays and across-the-board cuts, you can help blanket the Hill with our message. To send a message, go here. There you will find numerous studies, talking points, and a sample message that you can edit to include your experience and the negative impact home health and hospice cuts and copays would have on your patients. You can also call your elected officials. Find the phone numbers for elected officials in your state here. When calling, ask the receptionist to connect you with the person who handles Medicare issues.

Thanks for helping to making a difference!

Why Do Post-Acute Providers Need Access Prior to Discharge?

2011-10-24T10:24:00.000-05:00

By: Elizabeth E. Hogue, Esq.

Many post-acute providers; including home health agencies, private duty agencies, hospices, and home medical equipment (HME) companies, place a high value on use of coordinators/liaisons who regularly visit patient floors at hospitals and other inpatient facilities. Some discharge planners/case managers do not understand why such access is needed, especially in view of the availability of various methods of communicating information to post-acute providers. In fact, discharge planners/case managers may view the presence of post-acute providers as nothing more than a nuisance. There are, however, several reasons why the use of liaisons/coordinators from post-acute providers in institutional settings is important.

First, visits by liaisons/coordinators to patient floors are important for the provision of quality of care for patients. It seems increasingly clear that patients are at greater risk during transitions in care. Such transitions include shift changes in inpatient settings as well as movement from one level of care to another. Care transitions during which patients may be at increased risk also include transitions from inpatient care to post-acute care. According to Standards of Practice for Case Management published by the Case Management Society of America (CMSA) in 1995 and revised in 2002 and 2010, case managers/discharge planners have a duty to assist clients in the “safe transitioning of care to the next most appropriate level.”

While discharge planners/case managers may feel that they communicate all necessary information to post-acute providers, it seems likely that the more communication there is prior to discharge, the more likely it is that the transition will go smoothly. In order to help ensure a safe transition, coordinators/liaisons may be present on patient floors in order to talk directly with patients, to obtain more information from discharge planners/case managers, and to meet with families, especially primary caregivers, to help ensure that they understand their role in the provision of home care and hospice services. Consequently, the activities of coordinators/liaisons on patient floors may help to provide optimum transitions to patients from hospital or facility to home, and may help to manage the risks of both hospitals and facilities and post-acute providers.

It is also appropriate for liaisons/coordinators to be on site to visit patients with whom the post-acute provider has an ongoing relationship to help ensure continuity and quality of care. Home health patients whose episodes of care paid for by the Medicare Program do not end while patients are in the hospital or facility are still admitted to home health agencies and are still patients of the agencies. Hospice patients remain admitted for hospice care even though they are hospitalized. HME suppliers may maintain equipment in patients’ homes throughout their hospitalizations. Coordinators/liaisons can best stay in touch with patients of their organization and their families by visiting them in inpatient facilities. Post-acute providers need to have current knowledge about the clinical condition of patients, the availability of primary caregivers, the need for additional equipment and supplies, etc. in order to be able to continue to provide appropriate care upon discharge. Providers are legally prohibited from rendering services to patients whose needs they cannot realistically meet.

Coordinators/liaisons may also need to be on patient floors because they receive referrals that do not come from anyone at the hospital. Referrals may come from a variety of sources and may be received either verbally or in writing. Examples of referral sources include, but are not necessarily limited to: discharge planners, hospital and facility staff members, physicians, patients, and patients’ friends and family members. It is unnecessary for referrals to be received by the Agency in the form of orders from physicians or other practitioners. Post-acute providers may, for example, receive referrals from family members who seek services for patients. So coordinators/liaisons may need to be on patient floors in response to specific requests from family members to begin the process of coordination of post-acute services.

Based upon the above, liaisons/coordinators have legitimate needs to be on patient floors in inpatient settings. While solicitation of patients is impermissible, violations of this prohibition by some post-acute providers should not interfere with the ability of post-acute providers to meet the legitimate needs described above.

No portion of this material may be reproduced in any form without the advance written permission of the author.

NAHC Wrap-Up

2011-10-20T09:50:00.000-05:00

We hope you’re back in the swing of things after the 30^th Annual NAHC Annual Convention in Las Vegas a couple of weeks ago!

Daymarck team at NAHC 2011

We don’t know about you, but we thought it was one of the best conferences yet. During our three days exhibiting, we met hundreds of home care professionals from across the country and in all facets of the industry. We introduced our Pain-Free answer to coding and OASIS review to many, and heard feedback from numerous happy customers (here’s a video of one such instance).

Director of Business Development, Carie
Wright, conducting an ICD-10 survey

One of our favorite parts of this year’s show was learning what you thought of ICD-10 through iPad surveys in our booth. More than 230 of you shared your opinions and told us what you are doing to prepare for conversion. The survey spurred lots of great discussion and confirmed ICD-10 will be an important issue for the homecare industry leading up to conversion in October 2013. Stay tuned for the results of the survey which will be posted later this month.

A big thanks goes out to all who we got to meet at NAHC this year. And for those who couldn’t make it, feel free to check out our event photos, as well as this video from the show floor.

Please don’t hesitate to contact us any time to learn more about ICD-10 or discuss your home care coding needs.

Daymarck Welcomes Carie Wright

2011-09-30T09:22:00.000-05:00

We’re extremely pleased to introduce our new Director of Business Development, Carie Wright!

With more than 25 years of experience in the health care industry, Carie has fulfilled lead roles in data services and informatics sales, managed care formulary contracting, pharmaceutical sales, and consulting related to automated prescription tools. Carie holds a BBA in marketing from Stephen F. Austin University and is certified in Home Health and Managed Care Administration.

Here at Daymarck, she will be responsible for sales and account management. She will also participate in speaking at seminars, providing industry education, and cultivating strategic business opportunities.

If you’re heading to NAHC Annual, be sure to come by our booth (#862) to meet Carie!

NAHC Annual Meeting is Almost Here- Will you be there?

2011-09-26T10:13:00.001-05:00

The clock is winding down, and the 2011 NAHC Annual Meeting is almost here! We’re looking forward to meeting all the home healthcare professionals in Las Vegas in just a few short days.

If you’re attending the show, we hope you will take a minute to stop by our booth (#862) and learn more about Daymarck’s Pain-Free answer to OASIS review and home healthcare coding.

While you’re there, we also invite you to fill out our quick survey about converting to ICD-10. By participating, you will be eligible to win one of six casino-grade poker sets (a $150.00 value). Not attending? Don’t worry; you can fill out the survey now here.

You can also help us raise money for the Caring Institute by becoming a fan of Daymarck on either Facebook or Twitter by the end of the show. We’ll donate up to $1,000 to this deserving organization!

For those attending, we look forward to seeing you in Las Vegas! And if you can’t make it, stay tuned here and on Facebook or Twitter for updates during and post-show.

Fraud and Abuse Compliance: A “Wake-Up Call” for Private Duty Providers

2011-09-22T14:03:00.000-05:00

By: Elizabeth E. Hogue, Esq.

Agencies that provide private duty services only and Medicare-certified home health agencies that also provide private duty services may have erroneously concluded that the fraud and abuse prohibitions that apply to Medicare-certified agencies do not apply to private duty providers. Recent action against Maxim Healthcare makes it clear that this is not the case. Maxim is a privately held company with 360 offices nationwide and approximately 88,000 staff members. While some of these locations are Medicare-certified, Maxim provides services primarily to Medicaid, including Medicaid waiver, patients.

As a result of both criminal and civil investigations, Maxim has agreed to pay $150 million to the federal government and state Medicaid Programs to settle allegations of false claims. Payments to the federal government include false claims made to the Veterans Administration. In addition, nine employees of Maxim have already pled guilty to criminal charges; including three regional accounts managers, a Director of Clinical Services, a home health aide, an account manager, a recruiter, and a licensed practical nurse. Action may yet be taken against other individual employees, including members of the upper management team.

Based on this case alone, it is clear that providers of private duty services are subject to the same fraud and abuse prohibitions as Medicare-certified agencies and must take action to help ensure compliance. What kind of action should be taken by providers of private duty services?

The statements of officials about the Maxim settlement offer clear direction. New Jersey Attorney General Paula Dow, for example, said: “Companies like Maxim, that provide health care services to Medicaid patients, are expected to take necessary steps to prevent fraud and abuse by instituting strong compliance programs and maintaining effective internal controls.”

How do compliance programs, including effective internal control, help providers avoid enforcement action? First, as a practical matter, when providers establish and maintain a Compliance Program, it clearly discourages regulators from pursuing allegations of fraud and abuse violations. Technically speaking, the Federal Sentencing Guidelines make it clear that establishment and implementation of Compliance Programs is considered to be a mitigating factor. That is, if accusations of criminal conduct are made, as they were in the Maxim case, the consequences may be substantially less severe as a result of a properly implemented Compliance Plan.

Providers with Compliance Plans are more likely to avoid fraud and abuse. This is because Plans routinely establish an obligation on the part of each employee to prevent fraud and abuse and the Plans include training for all employees. Compliance Plans make it clear that employees have an obligation to bring any potential fraud and abuse issues to the attention of their employers first.

Compliance Plans may help to prevent qui tam, or so-called “whistleblower” lawsuits by private individuals, rather than by government enforcers, who believe that they have identified instances of fraud and abuse. There are significant incentives to bring these legal actions since “whistleblowers” receive a share of monies recovered as a result of their efforts. Some whistleblowers have received millions of dollars. The whistleblower in the Maxim case will receive over $15 million.

Finally, the Deficit Reduction Act (DRA) requires providers who receive more than $5 million in monies from the Medicaid Programs per year to implement policies and procedures, provide education to employees, and put information in their employee handbooks about fraud and abuse compliance. These requirements can be met through implementation of a Fraud and Abuse Compliance Program.

In view of the above, all providers of private duty services should implement and maintain effective compliance plans.

In addition, as part of an agreement to defer prosecution, Maxim admitted in documents filed in court that “certain aspects of Maxim’s operations emphasized sales goals at the expense of clinical and compliance responsibilities, as reflected in certain aspects of its culture, training, incentive compensation and allocation of personnel resources.” Based upon Maxim’s statement, providers of private duty services should review incentives in compensation to staff and should work to ensure that there are checks and balances on incentives that may encourage staff to engage in fraudulent conduct. These measures should be built into agencies’ compliance plans.

It is quite clear that providers of private duty services must meet requirements regarding fraud and abuse compliance. If they fail to do so, both criminal and civil enforcement action may be taken against them.

No portion of this material may be reproduced in any form without the advance written permission of the author.

New OIG Advisory Opinion on Provision of Items and Services Below Cost or Free of Charge to Referral Sources in Exchange for Referrals

2011-09-15T15:13:00.000-05:00

By: Elizabeth E. Hogue, Esq.

In an Advisory Opinion posted on August 4, 2011, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services concluded that the provision of items and services below cost or free of charge to referral sources likely violates the federal anti-kickback statute. A home medical equipment (HME) company requested the Advisory Opinion.

The HME supplier provides medical supplies and equipment to skilled nursing facilities (SNF’s). When the medical supplies and equipment that the HME company furnishes to SNF’s are covered by Medicare Part B, the HME company bills the Medicare Program for them. When they are not covered under Medicare Part B, the HME supplier bills the SNF for the supplies. The HME supplier usually charges SNF’s amounts in excess of the cost of the non-covered supplies in order to cover the cost of related services; such as inventory control, visits by customer service representatives, customized patient-specific packaging, etc.; plus overhead and profit.

In this case, SNF’s requested proposals for exclusive suppliers of items covered by the Medicare Program. Bidders were also required to submit pricing for items not covered by the Medicare Program that SNF’s may purchase at their option. The HME supplier wanted to submit bids offering pricing for the non-covered items and related services that were below the HME supplier’s costs. The HME company acknowledged that the payments it would receive from Medicare Part B as SNF’s exclusive suppliers for covered items would more than offset any losses it would incur to furnish the non-covered items and related services below its costs.

In response to the suppliers’ request, the OIG first stated that the anti-kickback statute is implicated if any direct or indirect link exists between a price offered by a supplier or provider to referral sources for items or services that referral sources pay for and referrals of Federal business for which the supplier or providers can bill a Federal health care program. According to the OIG, both referral sources and providers that receive referrals have obvious motives to trade below-cost payment rates for or free items and services for referrals of patients whose care will be paid for by the Medicare Program.

The OIG then pointed out that providers may be “swapping” the below-cost rates on certain types of business in exchange for other profitable Federal business from which providers can recoup losses incurred on the below-cost business. The OIG stated that providers likely engage in such practices with the intent of inducing referrals of more lucrative business paid for by the Medicare Program.

It is worth considering this Advisory Opinion in light of the practices of some hospital discharge planners/case managers. They may require post-acute providers to give services and/or supplies to patients for whom there is no payor source or payor sources that do not reimburse at rates that cover providers’ costs in order to receive referrals of patients whose care will be paid by the Medicare Program. If post-acute providers are unwilling to render services free of charge, hospitals may bear the risk of continued care of such patients. This type of “swapping” may also be prohibited by the OIG based upon the Advisory Opinion described above.

What do you think of ICD-10?

2011-09-09T11:43:00.000-05:00

There are many ICD-10 surveys out there, but none have focused on the home health community— until now.

We’re conducting an ongoing study of the home health community’s perceptions and preparations for the ICD-10 conversion, and want you to participate.

By participating in our survey, you’ll be registered in a drawing for a 300-piece poker set, in honor of the National Association for Home Care (NAHC) Annual Conference in Las Vegas October 1-5, 2011.

This is the first survey (open between September 9, 2011- October 6, 2011) as part of our ongoing study leading up to implementation in October 2013.0

Share your opinions on ICD-10 here!

NAHC Calls Selected Agencies to Participate in an Important Survey

2011-09-08T09:17:00.004-05:00

The National Association for Home Care & Hospice (NAHC) urges agencies that have been randomly chosen to partake in the Delta National Study to Reduce Avoidable Hospitalizations through Home Care study. The largest of its kind in the history of home care, this study addresses one of the single biggest quality problem facing home care agencies.

More than 700 agencies are expected to be surveyed via a 30-minute phone interview. As a thank-you, NAHC will provide participants with a special webinar and advance report on the best practice findings.

The study is also one of the most collaborative efforts ever initiated in home care. It is being sponsored by Delta Health Technologies and co-sponsored by NAHC. Affiliate sponsor groups also include the Joint Commission, Community Health Accreditation Program (CHAP), and the American Physical Therapy Association, among others.

The results will be released at the NAHC Annual Meeting and then made available free to all home care agencies in the United States.

So, if your agency is called, we urge you to participate. It can benefit your agency and the entire home care field.

ICD-10 Creates Need for Coding Specialists

2011-08-30T10:16:00.000-05:00

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

2011-08-08T12:08:00.001-05:00

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:

Plan to attend a congressional town hall meeting.
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.
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

2011-08-06T19:31:00.000-05:00

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

2011-08-01T16:19:00.000-05:00

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.

Part II – Accountable Care Organizations (ACO’s): The Role of Post-Acute Provider

2011-07-25T07:18:00.000-05:00

By Elizabeth E. Hogue, Esq.

Section 302 of the Affordable Care Act (ACA) includes provisions related to Medicare payments to providers of services and suppliers that participate in Accountable Care Organizations (ACO’s). Providers of services and suppliers who participate in ACO’s will continue to receive payments under Parts A and B of the Medicare Program, but will also be eligible for additional payments if they meet certain requirements related to quality of care and cost savings. The Secretary of the U.S. Department of Health and Human Services is required to establish ACO’s no later then January 1, 2012.

Proposed regulations to implement these provisions were published in the Federal Register on April 7, 2011. Comments regarding the proposed regulations must be received by the Centers for Medicare and Medicaid Services (CMS) no later than sixty days after the date of publication. This is the second in a series of articles about ACO’s. The purpose of this article is to address the issue of the role of post-acute providers in ACO’s. As indicated above, ACO’s will share in cost savings if they meet performance standards for both quality of care and cost savings. Post-acute providers may assist ACO’s to meet standards related to quality of care.

The Centers for Medicare and Medicaid Services (CMS) proposes to establish five “domains” related to quality of care. These domains are:

Better care for individuals, including patient/caregiver experiences, care coordination and patient safety.
Better health for populations, including preventive health and at-risk population/frail elderly health.

Post-acute providers have specialized expertise with regard to care coordination, patient safety and at risk populations/frail elderly health. Specifically, there are sixty-five proposed measures for use in establishing quality performance standard that ACO’s must meet in order to share in savings. Post acute providers may be especially helpful to ACO’s regarding the following performance measures:

Care Coordination/Transitions
The rate of readmissions within 30 days of discharge from acute care hospitals for assigned or aligned ACO beneficiary populations. Post-discharge visits to physicians within 30 days.

Ambulatory Sensitive Conditions Admissions: Diabetes, Short-term Complications (AHRQ Prevention Quality Indicator #1). All discharges of age 18 years and older with ICD-9-CM principal diagnosis code for short-term complications (ketoacidosis, hyper- osmolarity, coma) per 100,000 population.

Ambulatory Sensitive Conditions: Congestive Heart Failure (AHRQ Prevention Quality Indicator #8). All discharges of age 18 years and older with ICD-9-CM principal diagnosis code for CHF, per 100,000 population. Ambulatory Sensitive Conditions Admissions: Urinary Infections (AHRQ Prevention Quality Indicator #12).

All discharges of age 18 years and older with ICD-9CM principal diagnosis code of urinary trace infection, per 100,000 population.

Preventive Health
Influenza Immunization: Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

At Risk Population/Frail Elderly Health
Falls: Screening for All Risk: Percentage of patients aged 65 years and older who were screened for fall risk at least once within 12 months. Monthly INR for Beneficiaries on Warfarin: Average percentage of monthly intervals in which Part D beneficiaries with claims for warfarin do not receive an INR test during the measurement period.

Post-acute providers can certainly assist participants in ACO’s to meet the performance measures described above. The crucial role of post-acute providers in meeting the above goals should be recognized and acknowledged by other types of providers.

Elizabeth E. Hogue is an attorney in private practice with extensive experience in health care. Her clients are professional associations, physicians, managed care providers, and institutional health care providers, which includes hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices. © 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.

Call Congress: Home Health Care Cuts

2011-07-19T18:53:00.000-05:00

Congress is about to cut billions of dollars in funding for Medicare home health care services. Home health cuts and co-payments will have a devastating impact on millions of Americans, including some of the poorest and sickest Medicare beneficiaries. Such changes may also cause many patients to leave their homes and instead seek treatment in costly hospitals and nursing homes.

A Home Health Copayment:

Would Disproportionately Impact Poor and Sick Seniors
Would Shift Seniors to More Costly Settings
Would Increase Medicare and Medicaid Costs
Was Repealed by Congress in 1972 and Remains Unpopular Today

Please Protect Seniors from a Home Health Copayment. Join the Partnership for Quality Home Healthcare and contact your U.S. Representative today.

Recent OIG Advisory May Also Apply to Vendor Fees

2011-07-19T14:51:00.000-05:00

By Elizabeth E. Hogue, Esq.

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. In addition, post-acute providers continue to be plagued by hospitals that claim that post-acute providers cannot enter hospitals and/or gain access to patients to coordinate post-acute services because they are “vendors.” Hospitals may permit access by post-acute providers only if they comply with complex, inapplicable restrictions. Still other hospitals require post-acute providers to pay fees in order to gain access to patients for the purpose of coordinating post-acute services.

On the contrary, post-acute providers; such as home health agencies, home medical equipment (HME) companies, hospices, and private duty home care agencies; are not vendors and should not be treated like vendors. They are, instead, fellow providers. Vendors are manufacturers and distributors of supplies and equipment that are utilized by hospitals on their premises.

Does the OIG Advisory Opinion described above also apply to vendor fees?

First, since post-acute providers are not vendors, the payments of fees to hospitals directly or to hospitals’ contractors who implement vendor checks may constitute impermissible kickbacks. In addition, it appears that the OIG Advisory Opinion described above may indeed apply to vendor fees. The OIG’s main point is that post-acute providers cannot be required to pay fees in order to receive referrals, i.e. “pay to play.” If providers who pay vendor fees received referrals, but providers who do not pay fees do not receive referrals or receive fewer referrals, such practices seem to be prohibited by the OIG.

While post-acute providers certainly understand that hospitals may want to “credential” their vendors, it is inappropriate to treat post-acute providers and vendors and require them to pay fees to qualify or be “credentialed.” This practice seems to violate the OIG Advisory Opinion described above.

© 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.

Survey Results: Home Health Face-to-Face Requirements

2011-07-08T10:21:00.002-05:00

By Nick Dobrzelecki RN, BSN
Daymarck CEO

Since the start of Medicare’s home health face-to-face (F2F) requirement on April 1, 2011, agencies have encountered significant resistance from physicians in accurately and completely filling out the F2F documentation. The F2F encounter requirement must occur 90 days prior to the admission or 30 days after the admission. The documentation cannot be completed by any employee of the home health agency. The F2F documentation can be placed on the certification form or is an addendum to it but it must be separate and distinct. It must also include the following:

The patient's name;
Date of the encounter;
How the patient's clinical condition as seen during the encounter supports homebound status and the need for skilled services;
The physician's signature (original signature, a faxed copy, copy of original document with signature or electronic signature - but not stamped signature); and
Date of the physician's signature.

Agencies have been trying to educate and provide providers with as much help as is possible within the law. However, the regulation is very specific and constrains home health agencies from doing any of the work for the providers. Agencies can create forms but they cannot use check boxes or drop down boxes in electronic records. If the provider creates their own form, they can use these features although this is not clear as CMS continues to change their responses this issue. Issues such as stamp signatures continue to be an issue for some agencies (page 2, http://www.cms.gov/MLNMattersArticles/downloads/MM6698.pdf).

The National Association of Home Care and Hospice (NAHC) contracted Fabrizio, Ward & Associates to collect data from a survey conducted June 16-27, 2011 among physicians who prescribe home health care. 2,490 physicians from 49 states and DC responded to the survey (1,746 online, 744 by fax); the data has been weighted by region to reflect the actual distribution of the U.S. adult population.

Survey Results
View a PDF of the entire findings.

The vast majority of physicians surveyed disapprove of the new documentation/certification requirements for home health, saying it is a lot more burdensome and want it simplified. Most physicians surveyed believe fewer patients will be referred to home health as a result of the new rules, and that there will be significant negative health consequences to patients as a result. Most physicians surveyed favor reforms that would allow existing doctor orders to satisfy the certification requirements for home health, and do away with the written narrative. Half of physicians surveyed did not favor reforms that simplified the certification paperwork but still required a face-to-face visit.

Next Steps
Questions still linger who is going to monitor this requirement. It is not likely to be addressed by state survey agencies as F2F is not a Medicare condition of participation. It is a coverage and payment policy which may be monitored by a fiscal intermediary. With this issue not being answered, there are stories of agencies completing the documentation and then having the providers just sign off. This is in clear violation of the rules. When the rules allow hospital discharge planners to help complete the form for providers but home care liaisons cannot, the lines are clearly drawn. The only thing that can be done by the industry is to police its self. Violations can be reported to the HHS fraud hotline at http://oig.hhs.gov/fraud/report-fraud/index.asp.

NAHC Survey for Physicians: Spread the Word

2011-06-26T21:08:00.002-05:00

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:

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.
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 nick@daymarck.com.

Thanks in advance for your help.

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

2011-06-16T10:59:00.000-05:00

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.

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

2011-06-06T19:41:00.000-05:00

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.

ICD-10 Conversion: What Are You Most Concerned About?

2011-05-26T12:45:00.000-05:00

We all know that as of October 1, 2013, health providers will be required to adopt the new ICD-10 code sets. A recent study by HIMSS Vantage Point noted that the greatest challenge (one-third of respondents) organizations face as they undertake ICD-10 conversion is a lack of staffing resources. Another 19 percent noted that a lack of synchronization between payers and providers would present challenges.

We know there are a lot of questions and concerns about the conversion. The good news is that when you work with Daymarck on your coding needs, you can have confidence that our certified coders are up-to-date on ALL the latest regulatory changes.

Drop us a line or share your thoughts on the conversion in the comments section. We want to be there for you to make your coding as pain-free and as easy as possible.

The Old Adage: If It Is Not Documented, It Was Not Done

2011-05-17T19:19:00.000-05:00

By Elizabeth E. Hogue, Esq.

The old adage, “If it is not documented, it was not done;” is unfortunately often true. The consequences of failure to document may be severe in terms of allegations of fraud and abuse. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has repeatedly stated that providers carry the burden of proving that care was actually rendered to patients. If practitioners are unable to prove that they rendered appropriate care because it is not documented, the OIG and other fraud enforcers may conclude that claims submitted by these providers are false claims.

The consequences for submission of false claims are potentially severe. The amount of the false claims may, for example, be tripled and providers may be required to pay this amount. Millions of dollars and sometimes the ability of providers to continue their businesses may be at stake.

Consequences of submission of false claims also include suspension or exclusion from participation in the Medicare and Medicaid Programs, including Medicaid waiver programs, and other federal and state health programs such as Tri-Care. Few providers can survive the loss of all reimbursements from both federal and state healthcare programs.

Providers also risk liability for negligence or malpractice when they fail to document care provided. Risks are greatly enhanced when providers make recommendations to patients that they reject, and neither the recommendation nor refusal are documented. A recent case, Amos v. Louisiana Med. Mut. Ins. Co., No. 41, 302-CA (La. Ct. App. August 4, 2006) illustrates this point.

In this case, Dr. Rebecca L. Crouch treated Mr. Joseph Lee Amos for bleeding after bowel movements. Mr. Amos eventually sought a second opinion from a different doctor. The second physician Amos saw disagnosed colorectal cancer.

Amos sued Dr. Crouch and her professional liability insurer, Louisiana Medical Mutual Insurance Company. He claimed that Crouch breached applicable standards of care when she failed to recommend and conduct diagnostic testing indicated by Amos’ symptoms. Amos claimed that Crouch’s breach of standards of reasonable care caused a delay in diagnosis and treatment of his cancer.

In response, Crouch argued that she had, indeed, recommended to Amos that he undergo appropriate tests, but that he refused to allow such testing. Crouch, however, had not documented the recommendation or Amos’ refusal. Crouch testified that she remembered the conversation with Amos in which she recommended tests that he refused.

The Court concluded that the “absence in Mr. Amos’ medical records of any notations indicating that Dr. Crouch recommended he undergo either a proctoscopy or colonoscopy is circumstantial evidence from which the trier of fact could reasonably conclude that Dr. Crouch never made any such recommendations.” In other words, because it was not documented, it is reasonable to conclude that it was never done.

If allegations of fraud in the form of false claims had also been made against Dr. Crouch because the care she provided to Amos was substandard, it is likely that the allegations against her would have been substantiated.

A word to the wise should be sufficient: Documentation is crucial to avoid fraud and abuse and to manage risks.

Contact Elizabeth Hogue
Office: 877-871-4062
Fax: 877-871-9739
E-mail: ElizabethHogue@ElizabethHogue.net

© 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.

How to Work With Us

2011-05-02T07:31:00.000-05:00

Daymarck is Pain-Free Coding

We want to make it easy for you to work with us. This is why we have established simple methods to help with your coding needs. Read below to find out what we need from you to ensure accurate and efficient coding.

What we need
To ensure accurate ICD-9 codes to be assigned, the following information is required:

Referral information (i.e. why patient was referred to homecare)
OASIS/Comprehensive Assessment
Care Plan (it can be a draft)
Medication list at the time of the assessment

Additional Information that helps us accurately code:

History and Physicals
Hospital Treatment Notes
Discharge Notes
Therapy Evaluations

It is also very important to NOT send irrelevant information such as maps, driving directions, and blank pages. By eliminating those types of non-pertinent information, we are able to maintain a quick turnaround time and keep your costs low.

How we get the data

The quickest and most cost effective way, as far as time, fees and production, is one pdf file uploaded for each patient or case that needs coded. But we know that isn’t possible for every agency or situation. Talk to us and we can come up with a solution that works for you.

Here are a few ways our clients send us the data:

Run a few reports and put them together using Adobe Acrobat Pro or Standard or similar pdf creator.
Scan the paper and bind it together in one pdf file with the reports they ran out of their system.
Give Daymarck remote access into their electronic system via VPN or other remote access methods and we run the reports and create the patient document (additional fees do apply).
We accept faxes. Agencies who are on paper or prefer to print everything can then fax us patient documentation and it drops right into our system.
And, lastly, some agencies use a mix of both methods - they fax us a couple pages with a cover page and then we can remote in and get the info out of their system.

Patients' Right to Choose Providers

2011-04-05T10:06:00.000-05:00

By Elizabeth E. Hogue, Esq.

The right of patients to choose providers who will render care to them is currently based upon three key sources:

Court decisions that establish the right of all patients, regardless of payor source and the setting in which services are rendered, to control treatment, including who provides it.
Federal statutes for both the Medicare and Medicaid Programs that establish the right of patients whose care is paid for by these programs to choose providers who render care in the absence of a waiver.
The Balanced Budget Act of 1997 (BBA), which currently requires hospitals only to provide a list of home health agencies to patients. According to the BBA, the list must meet the following criteria:

Agencies that provide services in the geographic area in which patients reside, are Medicare-certified, and request to be included must appear on the list given to patients.
If hospitals have a financial interest in any agency that appears on the list, this interest must be disclosed on the list.

* Conditions of Participation (COP’s) of the Medicare Program that are the same as the provisions of the BBA described above.

Despite the existence of these requirements that are intended to protect the right of patients to choose providers, there is a lingering perception, however unfair it may be, that hospitals give “lip service” to patients’ right to freedom of choice, but still operate based upon a culture that emphasizes ownership of patients and the need, and perhaps even the right, to go to great lengths to keep patients “within the system.” Case managers/discharge planners are likely to see more enforcement actions by state survey agencies with regard to the rights of patients to choose their providers.

Action taken by a provider in Indiana is instructive. Specifically, the provider documented instances of alleged violations and reported them to the state survey agency. Surveyors treated the reports like a complaint and conducted a complaint survey of the hospital's practices. Surveyors concluded that the hospital violated its own policies and procedures and the provisions of the Balanced Budget Act in the process of making referrals for home health services. The hospital received a statement of deficiencies and was required to submit and follow a plan of correction (POC).

This action opens the door for clear enforcement action against hospitals and other providers who violate patients' right to freedom of choice. If violations are at the condition level of deficiencies, providers could, at least in theory, lose their right to participate in the Medicare/Medicaid Programs.

The right of patients to choose providers has generated considerable conflict within the provider community. This right is likely to be tested and reinforced. Case managers/discharge planners need a thorough understanding of the issues in order to stay out of the fray.

(To obtain more information about the fraud issues discussed above in a book entitled Medicare/Medicaid Fraud and Abuse: A Practical Guide for Providers, send a check to Elizabeth Hogue for $30.00 including 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: Report on Our Progress

2011-03-23T12:15:00.006-05:00

Making home health coding pain-free and easy. It’s your time to start feeling better.

by CEO Nick Dobrzelecki

In 2007 we started Daymarck with the vision to be THE leader in outsourced home health medical coding. We had the goal of making home health coding as easy and pain-free as possible for agencies of all sizes. February 2011 was our best month yet – and we keep having our best months, month-after-month. All the while improving on our goal of making coding pain-free for you.

Daymarck has grown more than 1000 percent from those early days. It has been a lot of hard work, and long days and nights, but I have been fortunate to have a great team in place and agencies that have benefited from our pain-free coding solution and helped spread the word about Daymarck. We have also learned a lot through our agency relationships and continue to grow daily.

Starting a company in 2007 was a leap of faith. It wasn’t the best economic environment for new business ventures, as we all know, but sometimes the best opportunities come during times of market contractions. And, I knew we had a great product and service that was needed in the marketplace. Daymarck filled a gap and, as we grow, Daymarck will continue to respond to regulatory changes in the home healthcare industry to make your job easier.

2010 Decision Health Home Coding Summit

In 2011, in response to our clients’ needs and what we have seen in the marketplace, we are planning to expand our offerings. Please follow us on LinkedIn, Facebook, YouTube and Twitter to keep up-to-date. In addition, please plan on meeting us face-to-face at these three important conferences where we will be sponsors and exhibitors: NAHC’s Annual Financial Management Conference & Exposition, July 13-15, 2011, San Diego; 9th Annual Home Health Coding Summit, August 8-12, 2011, Las Vegas, NV, and; NAHC’s Annual Meeting & Exposition, October 1-5, 2011, Las Vegas, NV.

We hope to see you at one or all of them. In the meantime, if you have questions about how we can alleviate your coding pains, feel free to drop me a line at nick@daymarck.com. And remember to follow us on Twitter and “Like” us on Facebook to stay up-to-date on the latest trends in the home healthcare coding industry.

Medicare Home Health Homebound Definition

2011-03-16T15:41:00.000-05:00

One of the most common questions we get asked is: "How do you define "homebound?" If this is a question you have, review the below information sheet put together by CEO Nick Dobrzelcki to set the record straight. If you still have questions after reading the info sheet, please contact us at nick [at] daymarck.com.

Homebound Definition

The statutory language (effective December 21st, 2000) clarified and broadened the homebound eligibility criterion in two ways:

Absences attributable to the need to receive health care treatment, including regular absences to participate in therapeutic, psychosocial, or medical treatment at a licensed or accredited adult day-care program, will not disqualify a beneficiary from being considered homebound.
Absences for the purpose of attending a religious service are deemed to be absences of infrequent or short duration. (Generally a beneficiary whose absences from the home are not considered infrequent or of short duration will not be considered to be homebound.)

The Current Homebound Definition in the Medicare Act reads as follows:

     An individual shall be considered to be “confined to his home” if the individual has a condition:

     • due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive devise (such as crutches, a cane, a wheelchair or a walker),
     • or if the individual has a condition such that leaving his or her home is medically contraindicated.

     While an individual does not have to be bedridden to be considered “confined to his home”, the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort by the individual, any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited, to furnish adult day-care services in the State shall not disqualify an individual from being considered to be “confined to his home”. Any other absence of an individual from the home shall not so disqualify an individual if the absence is of infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to an absence of infrequent or short duration. [42 U.S.C. 1395n(a)(2)(F)]
_______________________________________

U.S. Health and Human Services Secretary's clarification to Medicare's homebound definition: Directs providers to be more flexible in order to protect beneficiaries

On July 26, 2002 Tommy Thompson, Secretary of the United States Department of Health and Human Services, issued a press release and changes to the Medicare Home Health Agency Manual. The Secretary directed Medicare providers and contractors to be more flexible in applying the Medicare homebound criteria. This is important to elders and disabled Medicare beneficiaries as an individual must be confined to home (homebound) in order to qualify for Medicare home health coverage.

In particular, the Medicare Home Health Agency Manual, §§204.1-204.2, was amended to include additional, not all inclusive examples of situations in which the homebound criteria is met. (Family reunion, funeral, graduation.) More importantly, the following general language was added to the Manual:

It is necessary (as in determining whether skilled nursing services are intermittent) to look at the patient's condition over a period of time rather than for short periods within the home health stay. For example, a patient may leave the home (under the conditions described above, e.g. severe and taxing effort, with the assistance of others) more frequently during a short period when, for example, the presence of visiting relatives provides a unique opportunity for such absences, than is normally the case. So long as the patient's overall condition and experience is such that he or she meets these qualifications, he or she should be considered confined to home. (Emphasis added)

While the new language does not really add to the already existing homebound criteria, it does provide important direction that the criteria are to be applied flexibly and with a broad view of the patents’ condition. Advocates should use the Secretary’s press release language and the manual language to help make these points when clients are erroneously denied coverage.

CMS’ policy about the homebound status of home health patients who can drive

Just the fact that a patient drives does not automatically make them ineligible for homecare services. They issued clarification in 2008 which many providers do not follow. Within the clarification they specifically wrote:

“Homebound status is determined on an individual basis, looking at the patient as a whole. If the net effect of driving indicates that the individual has the capacity to get their health care routinely outside of the home, then it could challenge their eligibility. The fact that a patient is fit enough to drive raises questions as to whether the basic statutory requirement is met. Because individual circumstances can vary greatly, necessitating determinations on a case-by-case basis, we are reluctant to issue a specific policy that relates to driving in every possible occurrence. Inherent in such a policy would be judgments about the particular circumstances under which it may be appropriate for an individual to operate a motor vehicle. We believe that such determinations must continue to be made on a case-by-case basis.”

A friendly reminder to wash your hands.

2011-03-09T09:20:00.001-06:00

Face-to-Face Encounters by Medical Directors

2011-03-08T15:13:00.001-06:00

Learn more about the new face-to-face requirements that are going into effect on April 1, 2011 in an article written by Daymarck thought leader Elizabeth Hogue, a private practice attorney with extensive experience in healthcare law and policy.

Effective April 1, 2011, providers may not be paid for services rendered if patients have not had appropriate face-to-face encounters with physicians during required time periods. In order for home health agencies and hospices to be paid for services provided, documentation of these encounters must also meet applicable requirements. Many staff members of agencies and hospices have read communications from CMS, fiscal intermediaries, and other sources that seem to state that Medical Directors cannot provide face-to-face encounters and documentation of them in order to meet applicable requirements. This conclusion is stress-provoking for staff members because Medical Directors often refer a number of patients to them. If it is true that Medical Directors cannot complete face-to-face encounters and documentation of them, the new requirements are more likely to be problematic to implement.

On the contrary, Medical Directors and other referring physicians who receive payments from providers for their services may complete face-to-face encounters and documentation so long as the requirements of both the personal services and management contract safe harbor and the contractual exception are met, as described below.

It is important to note that the above requirements do not apply only to so-called “Medical Directors.” This requirement applies whether referring physicians who provide paid consulting services are called “Medical Directors,” “Medical Advisors,” “consulting physicians” or another title. In other words, the prohibition applies to all physicians who make referrals and are paid for services, regardless of their title.

For more information, download a PDF of the entire article.

Elizabeth E. Hogue, Esq.

No portion of this material may be reproduced in any form without the advance written permission of the author.

Question 2: Medicare home health patient who drives

2010-12-16T11:15:00.007-06:00

Determining homebound status is not as easy as it seems. This is in part to CMS's broad and non-specific definition. Most people within the homecare industry can recite that Medicare homecare patients have to have the condition "that there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort." After this, there is definite discrepancy in what this exactly means.

As far as driving, this fact does not automatically exclude a patient from home health services. CMS answered a Q&A in 2008 to this effect. The bigger picture has to be looked at.

Question 2 does not indicate if there is a considerable and taxing effort to leave the home thus the correct answer would be not enough information to make a decision.

Partial Code Freeze Prior to ICD-10 Implementation

2010-10-20T22:17:00.000-05:00

At the ICD-9-CM Coordination & Maintenance Committee Meeting (September 15, 2010), it was announced that the committee had finalized the decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10 on October 1, 2013. There was considerable support for this partial freeze.

The partial freeze will be implemented as follows:

• The last regular annual update to both ICD-9 and ICD-10 code sets will be made on October 1, 2011.
• On October 1, 2012 there will be only limited code updates to both ICD-9- CM and ICD- 10 code sets to capture new technology and new diseases.
• There will be no updates to ICD-9 -CM on October 1, 2013 as the system will no longer be a HIPAA standard.

On October 1, 2014 regular updates to ICD-10 will begin. The ICD-9 Coordination & Maintenance Committee will continue to meet twice a year during the freeze. At these meetings the public will be allowed to comment on whether or not requests for new diagnosis and procedure codes should be created based on the need to capture new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on or after October 1, 2014, once the partial freeze is ended.

To view the transcript of the meeting, go to: http://www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp. From there, select the September 15-16, 2010 meeting transcript in the download section, and then from the ZIP files, select the 091510_Morning_Transcript file. This section appears on page 4 of the 78-page proceeding.

A walk at NAHC

2010-10-04T13:38:00.000-05:00

Photos from Day 1 of NAHC

2010-10-04T10:01:00.000-05:00

Great Opening Night at NAHC 2010

2010-10-04T09:54:00.000-05:00

Wow, what a great start to the 29^th Annual National Association for Homecare and Hospice Expo. This year’s event is being held at the Gaylord Texan Resort on Grapevine Lake in Grapevine, TX, outside of Dallas. If you’ve never been here, it’s worth the trip. As they say, “everything is bigger in Texas” and that is no lie.

There are about 3,000 attendees and probably 300+ exhibitors with lots of energy. We posted a few videos on our YouTube channel to give you a feel of the festivities. You can also follow us on Twitter and be sure to like us on Facebook.

More to come later. Off to see former President George W. Bush give the keynote address.

More Than 10,000 Messages Sent Through NAHC LAN

2010-09-13T21:32:00.000-05:00

NAHC REPORT

Your Help is Needed

With Congress Back in Session, More Opportunities for Advocacy to Come

After outstanding campaigns by the home care community to ramp up grassroots actions urging members of Congress to stop home health cuts (NAHC Report, 8/12/10), the National Association for Home Care & Hospice (NAHC) is proud to share our success stories.

More than 9,600 messages were generated through NAHC's Legislative Action Network (NAHC LAN) urging members of Congress to cosponsor the Home Health Care Access Protection Act (S. 3315; H.R. 5803), which would help stop the Centers for Medicare & Medicaid Services (CMS) from implementing the $1.5 billion in home health regulatory cuts over the next two years included in its proposed rule on 2011 home health payment rates (NAHC Report, 8/9/10). Advocates also attended town hall meetings, invited their members on home care visits, and submitted letters to the editor of their local newspapers.

As the congressional recess wraps-up -- with the Senate returning to business today and the House tomorrow -- home care advocates have unique opportunities to follow up on their recess advocacy efforts by continuing to urge their members of Congress (including by engaging their health care staffers) to cosponsor the Home Health Care Access Protection Act. Advocates also can help build support for other pending legislation important to the home health community such as the Home Health Care Planning Improvement Act, which would allow nurse practitioners and physician assistants to sign home health plans of care (NAHC Report, 7/20/10). More than 2,000 messages have already been sent from the NAHC LAN supporting this bill.

Now that Congress is back from recess, senators and representatives will be making decisions about what bills to sponsor and will officially register their support. It is important to be persistent by asking that your senators and representative let you know if they will agree to sign on these bills. You may review the current list of cosponsors by clicking on the bill numbers (S. 3315; H.R. 5803), and then clicking on the link that says "Cosponsors."

This last stretch of Congressional activity before the November elections provides a short -- but dedicated and fervent -- four-week work schedule before members go out again to campaign. There has been some talk on Capitol Hill of Congress leaving even before October 8, so now is the time to step up advocacy and let members of Congress know the importance of these bills and the strength of home care advocacy.

'Lame Duck Session' Offers Further Opportunities for Advocacy

The tentative congressional schedule includes a plan to return after the November 2 elections for what is known as a "lame duck session" to deal with unfinished business, including an extension of the temporary fix to the Medicare physician payment formula and the exceptions process for the outpatient therapy cap. Without congressional action, the current physician payment fix will expire on November 30, resulting in a substantial reduction in physician payments. The exceptions process for the therapy cap expires on December 31.

When these Medicare issues are addressed, there should be opportunities to pursue home care priorities such as reforming the regulatory process for evaluating home health case-mix changes (provisions of the Home Health Care Access Protection Act) and the new face-to-face physician encounter requirements. Another change sought by home care advocates is allowing nurse practitioners and physician assistants to sign home health plans of care (the Home Health Care Planning Improvement Act). Stay tuned to NAHC Report for coverage of what promises to be a very intense time on Capitol Hill and for more action alerts.

Home Care Leadership - What Agencies must do to Survive

2010-08-20T08:46:00.000-05:00

As the debate over health care reform continues, home health agencies are facing an increasingly complex array of rules and guidelines that will dramatically reshape future business operations.

We've pulled out a great article written earlier this year by Daymarck's CEO and Founder, Nick Dobrzelecki, that discusses what home healthcare agencies must do to survive in this period of change.

Click here to read the full article. Feel free to post comments on your thoughts regarding this issue. We would love to get your perspective.

Why home health coders hold the edge as the healthcare arena continues to change

2010-08-11T13:30:00.001-05:00

Complexity of home health coding dwarfs hospital issues.

A little more than 10 years ago in home health (HH), an agency could code as it wanted, with few restrictions, and get reimbursed at a high rate with no annual patient cap. Coding didn’t matter, according to many, because there wasn’t stringent regulation surrounding it. It was a time of PAIN-FREE CODING (TM).

Learn about the signifigant regulatory changes that have taken place over the last decade or so, and see some of the issues that distinguish HH coding from hospital coding.

Read more of this article on the Daymarck website.

Decision Health Home Coding Summit

2010-08-11T08:55:00.000-05:00

Packed house at Daymarck-sponsored Decision Health Home Coding Summit 2010 in Philadelphia.

8th Annual Home Health Coding Summit

2010-08-10T10:19:00.001-05:00

This week August 8-12, for the second year in a row, Daymarck is a sponsor at the 8th Annual Home Health Coding Summit, the gold standard in coding education. The summit is being held at the Loews Philadelphia Hotel for the chance to network with fellow clinicians and coders. Check out our photos of the booth and who we are meeting.

Pictured here is Nick with Kathy Domenz, one of the first home care certified (HCS-D) coders at the program's inception in 2003.

Part I: Preparing for Audits - ZPIC Audits

2010-07-31T10:12:00.000-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

The Centers for Medicare and Medicaid Services (CMS) are now conducting ZPIC audits. ZPIC’s are conducted by Zone Program Integrity Contractors. Unlike RAC audits that target identification of overpayment and CERT audits that attempt to pinpoint improper payments, ZPIC audits focus on fraud in the Medicare Program. This means that ZPIC contractors can audit the integrity of all Medicare claims, both pre- and post-payment.

CMS has established seven ZPIC zones. Contracts have been awarded in three zones thus far, as follows:

 Zone 5 – AdvanceMed: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia
 Zone 7 – SafeGuard Services: Florida, Puerto Rico, and the Virgin Islands
 Zone 4 – Health Integrity: Texas, Colorado, New Mexico, and Oklahoma

ZPIC contractors are currently especially active in Zone 4.

Providers may encounter the following difficulties in connection with these audits:

 Requirements to copy a large number of charts to send to the ZPIC contractor within thirty (30) days of receipt of a request for them.
 If documentation sent by providers by ZPIC contractors is determined to be insufficient or is not received at all, claims are denied and monies recouped.
 ZPIC contractors may place providers on 100% prepayment review.

Clearly, providers need to prepare for these types of audits now.

A key area of review for ZPIC contractors for home care clients may be whether or not patients were homebound. If patients were not homebound, claims for services provided to them are false claims. Agency managers perceive that they are extremely vulnerable regarding this issue for at least two key reasons: (1) the standards used to determine homebound status remain ill-defined; and (2) since Medicare homecare services are provided only intermittently, as opposed to continuously, agencies are unable to verify homebound status with absolute certainty.

Generally, Medicare patients are considered to be homebound if they meet the following criteria:

(1) Patients leave home infrequently for only short durations of time for reasons other than to seek medical care that they cannot receive at home, and
(2) When homebound patients leave home, it must take great and taxing effort and/or require maximum assistance.

Patients may remain homebound, however, if they leave home to attend religious services and adult day care programs that meet certain requirements.

The difficulty that agencies have in interpreting these standards is evident. For example, what is a “short duration of time?” What is “great and taxing effort” or “maximum assistance?

Home health agencies must be prepared to respond to strict application of these standards by addressing two key questions:

(1) Does the patient's clinical condition support a conclusion that the patient is homebound?
(2) What is the patient actually doing?

Agency managers should take the following actions NOW:

1. Encourage staff members to spend less time and energy trying to understand how to interpret the standards summarized above. The standards remain difficult to understand, interpret, and apply. Even when staff members call regulators to ask for clarification or for determinations about specific cases, they may receive different answers, depending upon the person with whom they speak. In addition, staff cannot rely on verbal guidance given by regulators.

2. Staff should focus on “beefing up” documentation related to homebound status in the following ways:

 During the admission visit, inform each new patient about the criteria of homebound status and document that this information has been shared. Continuous quality improvement (CQI) staff members should audit retrospectively to verify that this information is provided to each new Medicare patient.

 Periodically, visiting staff should interview Medicare patients, either in person or via telephone, regarding whether they are homebound by asking pointed questions, such as:

- Have you left home since the last time I talked with you about this issue?

- If so, when?

- Where did you go?

- What did you do?

- How long were you gone?

- What assistance did you have each time you left home?

It may be helpful to ask nurses to obtain this information during supervisory visits. Some agencies include questions that prompt nurses to obtain this information on every visit. In addition, CQI staff should audit to make certain that this task is accomplished.

 When staff members know about a patients’ conduct that might indicate that they are no longer homebound, they must immediately report this information to their supervisors. Agency staff members can no longer afford to turn a “blind eye” or a “deaf ear” to this type of information that comes their way. Staff must document that they have reported this information to their supervisors. Supervisors, in turn, must investigate information they receive related to this issue. If further investigation clearly reveals that patients are no longer homebound, supervisors must take action to terminate services to these patients. If, however, further investigation indicates that patients’ homebound status is questionable, the team must hold case conferences to determine together whether the patients are still homebound. The results of these case conferences must, of course, be carefully documented.

 Agency staff should continue any documentation related to homebound status that they currently produce, including documentation of patients’ functional limitations.

The documentation described above must be written in plain language and be detailed enough that regulators with little knowledge of health care, much less home care, can readily see that agencies have been continuously monitoring patients' homebound status. Of course, there are no guarantees that patients are telling the truth or that auditors will not second-guess agencies on this issue anyway. The documentation described above makes it considerably harder, however, for auditors to disallow payments for visits or to find that agencies engaged in fraudulent or abusive conduct.

©2010

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.

Action Alert :

2010-07-22T22:06:00.000-05:00

Please encourage your congressional legislators to add their names as cosponsors of the Home Health Care Access Protection Act (H.R. 5803; S. 3315) introduced by Reps. Jim McGovern (D-MA) and Walter Jones (R-NC) and Sens. Susan Collins (R-ME) and Russ Feingold (D-WI). Go to NAHC Report, 7/15/10 for more information about this bill.

In light of the recent CMS rule that proposes to cut home health payments by 3.79 percent in 2010 and 3.79 in 2011 based on an unfounded allegation of "case mix creep" (NAHC Report, 7/19/10), this legislation is vitally important to preserve access to home health services because it would establish a fairer and more transparent process for evaluating case mix changes. Home health advocates also should ask their legislators to convey these significant concerns about payment cuts to CMS.

Click here and enter your zip code to find your federal legislators and their contact information. To access the text of the House bill and a list of House cosponsors, click here. To see the text of the Senate bill and a list of Senate cosponsors, click here. If your legislators have not yet cosponsored H.R. 5803 or S. 3315, please contact their offices and encourage them to do so. When calling, ask to speak with the staffer who handles Medicare issues. For talking points, click here.

To send an email on this issue to your members of Congress using the NAHC Legislative Action Network, click here. We encourage you to edit the sample email provided there by adding information about your own background and experience and the impact these payment cuts could have on home health patients in your state.

Join us for Upcoming Events

2010-07-13T12:07:00.000-05:00

Over the next several months, Daymarck will be at industry shows where we hope to meet you, learn more about your home health agency, and tell you more about how we can make your home care coding as easy and pain-free as possible.

Tomorrow July, 14 we will be attending the NAHC and HHFMA 16th Annual Financial Management Conference & Exposition at the Sheraton Chicago Hotel & Towels. At a NAHC Conference, be sure to participate in user groups meetings, client appreciate receptions, in-booth educational sessions and more.

Nick and George will be at Booth # 301 so stop by for a free cost analysis and don't forget to pick up a calculator. If you are not able to attend, follow @Daymarck during the event for updates.

For the second year in a row, we are sponsors of Decision Health's Home Health Coding Summit at Loews Philadelphia Hotel August 8-12 to join expert coders and network with your peers while participating in an exclusive day of interactive, advanced-level coding and celebration of 2,010 certified coders in 2010! Plus new in 2010: Procedure coding — a new requirement for home health agencies — along with OASIS-C and coding interactions. In addition to being an exhibitor hosting a booth, we will be sponsoring the luncheon session where we are gathering thought leaders in a panel discussion. Stay tuned for more details.

Last, but not least, mark your calenders for October 2-6! Daymarck will be at the 2010 National Association for Home Care & Hospice 29th Annual Meeting & Exposition in Dallas, TX.

Feel free to reach out to us at anytime with questions. We look forward to seeing you at all of the upcoming events!

Changes in Referral Relationships with Physicians

2010-07-09T14:20:00.000-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

Significant changes are likely in the near future in relationships between providers and referring physicians. Trade associations, for example, are providing substantial guidance for their members on this subject. PhRMA, a trade association whose members are pharmaceutical research and biotechnology companies, recently updated its Marketing Code. The revised Code was applicable as of January 1, 2009. Although the Code applies only to members of PhRMA who voluntarily agree to follow it, the Code has helped providers to understand changing standards regarding acceptable marketing practices.

With regard to taking lunches to physicians’ offices, for example, the revised Code says that PhRMA members who elect to adhere to the Code may present information to healthcare professionals and their staff members during the workday, including at mealtimes. In connection with such presentations or discussions, the Code also says that it is appropriate for occasional meals to be offered as a business courtesy to the participants. The presentations must, however, provide scientific or educational value and meals must meet the following standards:

- Modest, by local standards;

- Not part of an entertainment or recreational event;

- Provided in a manner conducive to informational communication; and
- Limited to in-office or in-hospital settings.

Federal regulators have been active for many years in oversight and monitoring of referral arrangements with physicians and will surely continue to do so. The bases for these activities include the federal anti-kickback statute and the so-called Stark laws. Many states have enacted statutes and implemented regulations governing referrals.

State courts have also addressed these issues. In Sloan v. South Carolina Board of Physical Therapy Examiners, No. 26209 (S.C. Sept. 25, 2006), for example, the Supreme Court concluded that a state statute prohibits physical therapists from being employed by physicians who refer patients to them for therapy services. The Court also specifically recognized the right of the state’s Board of Physical Therapy Examiners to enforce the statute against therapists who violate it.

Recent activity seems to indicate that state legislatures and licensure boards are likely to further regulate these relationships even more aggressively. State licensure boards in New Jersey, for example, may require physicians to refuse lunches provided by representatives of pharmaceutical manufacturers. Physicians may also be required to disclose payments of more then $200.00 as a condition of licensure.

There seems to be a perception among state governments that federal regulation of relationships between physicians and providers who receive referrals from them has been ineffective. Consequently, state regulation is likely to become more extensive and frequent. Stay tuned for more information about this important trend.

©Copyright, 2010. 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.

2010-06-17T11:41:00.001-05:00

NAHC Report Article

Thursday, June 17, 2010

________________________________________

Fifty Representatives Endorse Home Health Care Planning Improvement Act

Bills Would Allow NPs, PAs, and Other Professionals to Sign Home Health Plans of Care

With the help of home care advocates, Rep. Allyson Schwartz (D-PA) has garnered 50 cosponsors for her legislation, the Home Health Planning Improvement Act of 2010 (H.R. 4993). The National Association for Home Care & Hospice (NAHC) thanks all home care advocates who helped encourage their representatives' support for this legislation (NAHC Report, 4/28/10) The bill would allow nurse practitioners (NPs), clinical nurse specialists, and physician assistants (PAs) to order home health services under Medicare in accordance with state law.

Rep. Schwartz -- who serves on the House Ways and Means Committee, which has jurisdiction over Medicare and Medicaid -- and the bill's Republican cosponsor, Walter Jones (R-NC), have been circulating a new, bipartisan "dear colleague" letter describing the bill and seeking cosigners among fellow House members.

"Even though nurse practitioners and physician assistants are currently able to order nursing home care for Medicare beneficiaries, they are not able to order less costly home care services," Schwartz and Jones point out in the letter. "The Home Health Care Planning Improvement Act, H.R. 4993, would ensure that our Medicare beneficiaries get the home health care they need in a timely manner." You can help by downloading the letter and forwarding it to your representative's office -- see below for information to help you do so. In addition, Sens. Susan Collins (R-ME) and Kent Conrad (D-ND) have introduced a Senate companion bill (S. 2814), and NAHC urges all home care advocates to encourage their senators to add their names as cosponsors.

TAKE ACTION: Have your congressional legislators added their names to these important bills?

Click here and enter your zip code to find your federal legislators and their contact information. If your members of the House and Senate have not yet cosponsored H.R. 4993 or S. 2814, respectively, please contact their offices and encourage them to do so. When calling, ask to speak with the staffer who handles Medicare issues. To send an email on this issue to your members of Congress using the NAHC Legislative Action Network, click here.

Why Discharge Planners/Case Managers Need to Know About Legal Implications of Provision of Free Services to Patients

2010-05-26T10:30:00.001-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-Mail: ElizabethHogue@ElizabethHogue.net

Based upon their overriding commitment to patients, case managers or discharge planners may be tempted to “take up the slack” by urging post-acute providers to render free or voluntary services to patients. Case managers/discharge planners may state to post-acute providers that they will not receive additional referrals unless they agree to provide services to so-called “indigent patients,” some of whom may not have a payor source for their care.

Staff members who provide free services and organizations that allow staff members to do so run the risk of engaging in fraudulent conduct. Specifically; to the extent that free or voluntary services are perceived as an inducement to patients to initiate, continue, or re-initiate services with particular providers; organizations and practitioners may run the risk of violation of Medicare/Medicaid fraud and abuse prohibitions, especially the federal anti-kickback statute. Violations may also occur if provision of free services is an inducement for additional referrals, as described above. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS), a primary source of enforcement activity, has clearly stated that the provision of free services to beneficiaries may constitute a violation of these prohibitions.

The OIG has also clearly delineated limits on free items and services that may be provided to patients. Providers may give patients only non-cash items of nominal value. Non-cash items, including free services, may not exceed $10.00 in value at a time and $50.00 in value during a calendar year. Most post-acute services, including even one visit to a patient’s home, clearly exceed these limits.

This position may strike discharge planners/case managers as confusing and perhaps contradictory. Since the point of enforcement is to prevent unnecessary costs, shouldn’t the government welcome the provision of free services to beneficiaries by providers that save money, since they are free? Nonetheless, the government’s point of view is that, when free services result in additional utilization of services, there is a potential fraud problem.

The question of whether free services induce beneficiaries to utilize services paid for by the Medicare/Medicaid and other federal and state healthcare programs that they otherwise would not have utilized is certainly a tricky one to answer. In the current environment of hypersensitivity to fraud and abuse, the best course of action for post-acute providers is likely to completely avoid the provision of free services to patients.

In response to these concerns, providers may wish to develop and implement a policy that permits provision of so-called “charity care” after the requirements of the policy have been met. At a minimum, such policies should require providers to bill patients three times before writing off the services as “charity care.” This practice is likely to help “shield” providers from allegations of fraud.

The good intentions and fine motivations of case managers/discharge planners must be acknowledged. The “bottom line,” however, is that the provision of free services is problematic in today’s healthcare environment and should be avoided for all of the above reasons.

©2010

Elizabeth E. Hogue, Esq. All rights reserved.

No portion of these materials may be reproduced in any form without the advance written permission of the author.

The Latest on the Red Flags Rule

2010-05-18T13:12:00.000-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

The Federal Trade Commission (FTC) will begin enforcement of the Red Flags Rule on June 1, 2010. This Rule was created to ensure that certain types of organizations are doing everything in their power to identify, prevent, and reduce incidences of identity theft. Most health care providers are subject to this Rule that requires businesses to develop identity theft Programs tailored to the characteristics of their organizations. Although the FTC will not take any enforcement action before June 1, 2010, providers are still required to comply. (See information below regarding available materials.) There is, however, legislation pending in Congress that may change requirements to comply with the Rule.

Specifically, on October 8, 2009 H.R. 3763 was introduced into the House of Representatives. This proposed bill would amend the Fair Credit Reporting Act to exclude small businesses, including some health care providers, from Red Flags Rule requirements. This legislation was passed by the House of Representatives on October 21, 2009. It is currently being reviewed by the Senate Committee on Banking, Housing, and Urban Affairs. Section 1 of the proposed legislation provides as follows:

(4) EXCLUSION FOR CERTAIN SMALL BUSINESSES – For purposes of this subsection, the term ‘creditor’ shall not include—

(A) a health care practice with 20 or fewer employees;…or

(D) any other business, if the Commission determines, following an application for exclusion by such business, that such business—

i   knows all of its customers or clients individually;

ii   only performs services in or around the residences of its customers; or

iii   has not experienced incidents of identity theft and identity theft is rare for businesses of that type.

(5) DEFINITIONS – For purposes of this subsection:

(A) EMPLOYEE – With respect to a business, the term ‘employee’ means any individual who works for such a business and is paid either wages or a salary.

(B) HEALTH CARE PRACTICE –

(iv) IN GENERAL – The term ‘health care practice’ means a business that’s primary service is providing health care via health care professionals employed by the business.

(v) HEALTH CARE PROFESSIONAL – For purposes of subparagraph (A), the term ‘health care professional’ means an individual engaged in providing health care and licensed under State law, including physicians, dentists, podiatrists, chiropractors, physical therapists, occupational therapists, marriage and family therapists, optometrists, speech therapists, language therapists, hearing therapists, and veterinarians

If this proposed legislation is enacted, the Red Flags rule may not apply to some providers. Some providers may also qualify for an exclusion from the Rule, as indicated above.

There’s always something new in healthcare!

We have developed materials for you to use to meet the requirements of the Rule. The materials are appropriate for use by all providers, including home health agencies; private duty agencies; hospices; HME suppliers; and individual providers, such as therapists, ALF’s/ILF’s, physicians, etc. The materials include a comprehensive Policy, as required by the Rule, which should be used to provide training that is also mandated by the Rule. In addition, the materials include a resolution to be adopted by the governing body per the Rule.

The cost of these materials is $200.00. Please send a check made out to Elizabeth E. Hogue, Esq. to: Fulfillment, 107 Guilford, Summerville, SC 29483. We are unable to accept credit cards. Please be sure to include the name and e-mail address of the person who should receive the materials. We will e-mail them to the designated recipient upon receipt of payment.

©2010
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.

Why Discharge Planners/Case Managers Need to Know About Legal Implications of Provision of Free Services to Patients

2010-05-07T11:16:00.001-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-Mail: ElizabethHogue@ElizabethHogue.net

Based upon their overriding commitment to patients, case managers or discharge planners may be tempted to “take up the slack” by urging post-acute providers to render free or voluntary services to patients. Case managers/discharge planners may state to post-acute providers that they will not receive additional referrals unless they agree to provide services to so-called “indigent patients,” some of whom may not have a payor source for their care.

Staff members who provide free services and organizations that allow staff members to do so run the risk of engaging in fraudulent conduct. Specifically; to the extent that free or voluntary services are perceived as an inducement to patients to initiate, continue, or re-initiate services with particular providers; organizations and practitioners may run the risk of violation of Medicare/Medicaid fraud and abuse prohibitions, especially the federal anti-kickback statute. Violations may also occur if provision of free services is an inducement for additional referrals, as described above. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS), a primary source of enforcement activity, has clearly stated that the provision of free services to beneficiaries may constitute a violation of these prohibitions.

The OIG has also clearly delineated limits on free items and services that may be provided to patients. Providers may give patients only non-cash items of nominal value. Non-cash items, including free services, may not exceed $10.00 in value at a time and $50.00 in value during a calendar year. Most post-acute services, including even one visit to a patient’s home, clearly exceed these limits.

This position may strike discharge planners/case managers as confusing and perhaps contradictory. Since the point of enforcement is to prevent unnecessary costs, shouldn’t the government welcome the provision of free services to beneficiaries by providers that save money, since they are free? Nonetheless, the government’s point of view is that, when free services result in additional utilization of services, there is a potential fraud problem.

The question of whether free services induce beneficiaries to utilize services paid for by the Medicare/Medicaid and other federal and state healthcare programs that they otherwise would not have utilized is certainly a tricky one to answer. In the current environment of hypersensitivity to fraud and abuse, the best course of action for post-acute providers is likely to completely avoid the provision of free services to patients.

In response to these concerns, providers may wish to develop and implement a policy that permits provision of so-called “charity care” after the requirements of the policy have been met. At a minimum, such policies should require providers to bill patients three times before writing off the services as “charity care.” This practice is likely to help “shield” providers from allegations of fraud.

The good intentions and fine motivations of case managers/discharge planners must be acknowledged. The “bottom line,” however, is that the provision of free services is problematic in today’s healthcare environment and should be avoided for all of the above reasons.

©2010
Elizabeth E. Hogue, Esq. All rights reserved.
No portion of these materials may be reproduced in any form without the advance written permission of the author.

Part 1 – Health Care Reform: Physicians and Patients’ Right to Freedom of Choice of Providers

2010-05-05T11:28:00.001-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

To date, only hospitals are required to present lists of some types of providers to patients so that they can choose which providers they want to render services to them. Likewise, statutes in some, but not all states, require physicians and other types of providers to give notice to patients if they have financial/ownership interests in providers to which they make referrals. As a result of health care reform, the “picture,” with regard to physicians and patients’ right to freedom of choice, is about to change.

Specifically, physicians who make referrals for certain types of imaging services are required to inform patients in writing at the time referrals are made that patients may obtain services from providers of their choice. Physicians are also required to provide patients with a list of providers who supply such services in areas in which patients reside. It appears that the Secretary of the U.S. Department of Health and Human Services (DHHS) may also have the discretion to apply this requirement to other designated health services (DHS) under the so-called Stark laws, including home health and HME services.

The Patient Protection and Affordable Care Act (PPACA) provides as follows:

(a) In General – Section 1877(b)(2) of the Social Security Act (42 U.S.C. 1395nn(b)(2)) is amended by adding the following new sentence: ‘Such requirements shall, with respect to magnetic resonance imaging, computed tomography, positron emission tomography, and any other designated health services specified under subsection (h)(6)(D) that the Secretary determines appropriate, include a requirement that the referring physician inform the individual in writing at the time of the referral that the individual may obtain the services for which the individual is being referred from a person other than a person described in paragraph (A)(i) and provide such individual with a written list of suppliers (as defined in section 1861(d)) who furnish such services in the area in which such individual resides.’

(b) Effective Date – The amendment made by this section shall apply to services furnished on or after January 1, 2010.
Although there is a lack of clarity about whether the above criteria related to imaging services require immediate compliance or compliance only after the Secretary has published final regulations implementing this section, it is clear that physicians will be required to present lists of imaging providers to their patients and to inform of their right to choose.

Physicians are currently required to abide by patients' right to freedom of choice of providers. In addition to the state statutes described above, there are two sources of this right that apply to physicians:

1. All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. Thus, when patients voluntarily express preferences for certain providers, their choices must be honored regardless of payor source or type of care.

2. Federal statutes of the Medicare and Medicaid Programs guarantee Medicare beneficiaries and Medicaid recipients the right to freedom of choice of providers. (Medicaid recipients may have waived this right if they participate in waiver programs.) Consequently, when Medicare patients and non-waiver Medicaid patients voluntarily express preferences for providers, these choices must be honored.

If patients voluntarily express preferences or choose providers other than those ordered by their attending physicians, then patients’ choices “trump” physicians’ orders and must be honored.

Practitioners may view these new requirements with skepticism. After all, as a practical matter, many patients are likely to choose providers recommended by their physicians. Some practitioners may also view the presentation of lists to patients as promotional opportunities for providers required to present such lists. Comments to the preamble of “safe harbor” regulations published by the Office of Inspector General (OIG) seem to reinforce this point:

Comment: Commenters overwhelmingly supported requiring health care providers to disclose to patients any financial relationships with sources of referral. They argued that such disclosure would not be burdensome, and that many codes of professional ethics, as well as many state statutes, already mandate such disclosure.

Response: With one exception, we have decided not to require such disclosure to qualify under a particular safe harbor provision. First, the activities covered under each safe harbor provision are by definition activities that we deem to have a low potential for abuse. Second, disclosure in and of itself would not provide a significant additional assurance that abuse would not occur, even though disclosure may reduce the potential for abuse somewhat by increasing consumer awareness of the relationship between health care providers. Finally, it is possible for a health care provider to cast a disclosure to fit that provider’s promotional objective, which is exactly the opposite result from that which we would want to achieve.

Despite such skepticism, it is clear that competition among providers continues to “heat up,” and that legislators and regulators are determined to address the issue of patients’ right to freedom of choice. It is also clear that, despite fierce competition among providers, the rights of patients cannot be trampled.

©2010
Elizabeth E. Hogue, Esq. All rights reserved.
No portion of these materials may be reproduced in any form without the advance written permission of the author.

Physicians and Patients’ Right to Freedom of Choice

2010-05-03T12:55:00.001-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

Providers are increasingly concerned that physicians may violate patients' right to freedom of choice of providers.
First, it is important to note that longterm care, home health, including some services provided by private duty agencies, home medical equipment (HME) and hospice services are provided under the supervision of physicians based upon specific orders from them. Because physicians supervise these types of services, they are at risk for legal liability, along with providers and staff members, if providers supervised by physicians do no meet applicable standards.
Consequently, physicians have a clear interest in assuring the quality of care rendered by other providers to their patients. Physicians may, therefore, choose to designate in their orders which providers will render services to their patients in order to help assure quality of care and manage their risks of liability.

Nonetheless, all providers, including physicians, are required to abide by patients' right to freedom of choice of providers. There are two (2) sources of this right that apply to physicians:

1) All patients have a common law right based upon court decisions to control the care provided to them, including who renders it. Thus, when patients, regardless of payor source or type of care, voluntarily express preferences for certain providers, their choices must be honored.

2) Federal statutes of the Medicare and Medicaid Programs guarantee Medicare beneficiaries and Medicaid recipients the right to freedom of choice of providers. (Medicaid recipients may have waived this right, if they participate in waiver programs.) Consequently, when Medicare patients and non-waiver Medicaid patients voluntarily express preferences for providers, these choices must be honored.

Consequently, physicians' orders based upon quality of care concerns for specific providers should be implemented unless patients express preferences to receive services from different providers.

If, however, patients voluntarily express preferences or choose providers other than providers ordered by their attending physicians, patients' choices "trump" physicians' orders and must be honored.
Physicians may then choose whether or not they wish to supervise services and assume the risk of services provided by providers different from those they ordered.

It is at this point that physicians and their office staff members must be especially cautious. If they try to "strong arm" patients into receiving services from providers physicians' prefer instead of providers chosen by patients, consent to such services may not be voluntary. Statements by physicians or their employees, for example, that the doctor will no longer care for them if they do not accept services from the provider the doctor ordered may amount to duress which invalidates any consent by patients to such services.
Attempts to force patients to accept physicians' choices have ethical implications as well. Patients' right to act autonomously may be compromised by the insistence of physicians or staff members.

From a very practical point of view, physicians who are serious about quality of care and sound risk management should talk to patients about their preferences for providers before they write orders for specific providers. Patients will then have an opportunity to understand physicians' preferences, to express their own choices and/or to resolve any differences between physicians and patients.

Discharge planners/case managers who encounter instances in which physicians and their employees put inappropriate pressure on patients to use providers chosen by physicians should carefully document violations of patients' right to freedom of choice. Documentation should preferably be in the form of signed statements from patients. These statements should be forwarded to physicians with a letter from providers/case managers. A word to the wise should be sufficient!

Practitioners who encounter physicians who persist in pressuring patients despite their letters and documentation from patients may wish to report violations to both the central and regional offices of the Centers for Medicare and Medicaid Services (CMS). Such reports should include documentation from patients.
The competition among post-acute providers continues to "heat up." The rights of patients, however, cannot be trampled despite fierce competition among providers.

©Copyright, 2010.
Elizabeth E. Hogue, Esq. All rights reserved.
No portion of these materials may be reproduced in any form without the advance written permission of the author.

Advance Practice Reform

2010-05-03T07:00:00.001-05:00

I was recently asked, why allowing advance practice providers to order and supervise patients under homecare services was needed. Here was my response:

First everyone needs to be clear what the Federal Register states:

§ 484.18 Condition of participation: Acceptance of patients, plan of care, and medical supervision states, “Care follows a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine.”

This federal regulation supersedes any state nurse practice acts that would allow nurse practitioners to provide this oversight. There are multiple reasons why H.R. 4993 bill or S. 2814 needs to be passed. Senator Collins (D-Maine) did a wonderful job outlining some of these reasons in her statement in November of 2009. Her statement can be found in one of my previous blogs.

I see this legislation being a critical first step in reforming home health care and positioning the industry to be a critical player in overall healthcare reform. There are several possible changes that will occur over the next few years as a result of healthcare reform. These changes include value-based purchasing (A.K.A. pay for performance) and post-acute bundling. I envision nurse practitioners as key solutions for these challenges.

I predict that nurse practitioners will be on staff in many home health agencies during the next decade. They will be in charge of disease management programs, case managing complex patients, and providing direct care to patients. The direct care will consist of caring for those patients exhibiting acute exacerbations of their disease. Instead of going to the ER or delaying treatment while waiting for a physician appointment, the NP would see those patients at home and order the appropriate treatment. This would decrease healthcare costs while accelerating patient outcomes and increasing patients’ overall satisfaction.

An example would be a Chronic Congestive Heart Failure patient beginning to experience an acute exacerbation. Currently, most agencies would notify the physician who then would instruct the patient to go to the ER. The ER physician, not knowing this patient feels this patient need to be hospitalized to be diuresed. After the expensive ER visit and several days in the hospital, the patient is diuresed.

Instead say that nurse notified the NP on staff. They see the patient in home and complete an assessment. Complete any necessary lab work then orders diuretics for the patient while at home. The agency increased the visits over the next few days until the patient stabilizes. This would cost a fraction of the ER/hospitalization bill.

In order to achieve this first step towards higher quality patient care, H.R. 4993 needs to be passed now. As health care reform becomes clearer, many groups will be aiming to be on top of the heap. If these bills are not passed now, I worry that physician lobbyist groups will fight much more fiercely in the future to not allow advance practice providers to practice in the homecare setting as is the case now. The home health industry is in a terrific position to become a major player in health reform. In order to situate ourselves to be a major stakeholder with Healthcare Reform, we must pass H.R. 4993.

Bills Would Allow NPs, PAs, and Other Professionals to Sign Home Health Plans of Care

2010-04-29T09:11:00.004-05:00

Rep. Allyson Schwartz (D-PA) has jumped into the fight to pass overdue commonsense legislation (H.R 4993) which would allow for NPs, PAs and other professionals to sign home care Plans of Care. Senators Susan Collins (R-ME) and Ken Conrad (D-ND) had previously reintroduced a Senate Bill (S. 2814) that would also allow for this. That Senate Bill is currently at the Senate Finance Committee for review. No additional Senators have signed up to be cosponsor since it was introduced November 20, 2009.

The House version has had 37 cosponsors of the bill. Rep. Schwartz has been circulating a "dear colleague" letter describing the bill and asking for additional cosigners.

Here is a list of those who have signed on to these bills:

H.R. 4993
Rep. Allyson Schwartz (D-PA, sponsor) Rep. Tammy Baldwin (D-WI) Rep. Leonard Boswell (D-IA) Rep. Bruce Braley (D-IA) Rep. Dennis Cardoza (D-CA) Rep. Kathy Castor (D-FL Rep. Gerry Connolly (D-VA) Rep. Kathleeen Dahlkemper (D-PA) Rep. Rosa DeLauro (D-CT) Rep. Chaka Fattah (D-PA) Rep. Raul Grijalva (D-AZ) Rep. Jane Harman (D-CA Rep. Paul Hodes (D-NH Rep. Barbara Lee (D-CA) Rep. Patrick Murphy (D-PA) Rep. Ed Perlmutter (D-CO) Rep. Lucille Roybal-Allard (D-CA) Rep. Kurt Schrader (D-OR) Rep. Carol Shea-Porter (D-NH)
Rep. Peter Welch (D-VT) Rep. Earl Blumenauer (D-OR) Rep. Robert Brady (D-PA) Rep. Lois Capps (D-CA) Rep. Christopher Carney (D-PA) Rep. Mike Coffman (R-CO) Rep. Joe Courtney (D-CT) Rep. Peter DeFazio (D-OR) Rep. Sam Farr (D-CA) Rep. John Garamendi (D-CA) Rep. Deborah Halvorson (D-IL) Rep. Alcee Hastings (D-FL) Rep. Walter Jones (R-NC) Rep. Carolyn McCarthy (D-NY) Rep. John Olver (D-MA) Rep. Chellie Pingree (D-ME) Rep. Janice Schakowsky (D-IL) Rep. Jose Serrano (D-NY) Rep. Diane Watson (D-CA)

S. 2814
Sen. Susan Collins (R-ME, sponsor) Sen. Kent Conrad (D-ND, original cosponsor)

You can help by notifying your representatives of you support and encourage them to support these important bills.

FDA Asks Your Input on Negative Pressure Wound Therapy

2010-04-23T08:05:00.000-05:00

The Food and Drug Administration's (FDA) Center for Devices and Radiological Health (CDRH) has requested valuable input from users of Negative Pressure Wound Therapy (NPWT) systems in the home environment.

FDA has received reports of adverse events associated with NPWT systems, especially those used at home and at extended care facilities. Since wound care can take place in the home and can be self-initiated, managed, or used with the help of a trained caregiver (often a family member), FDA wants to hear about your experiences with these systems.

If you use NPWT in the home environment and are willing to participate in an important FDA survey related to this treatment, please click on the link below and you'll be directed to a brief survey questionnaire. FDA notes that your information will be used strictly for this purpose and responses to the questionnaire will remain confidential, and thanks all those who participate. To take the survey, please go to https://vovici.com/wsb.dll/s/2ff9g430f1.

Should HIPAA Business Associate Agreements be Modified to Comply with HITECH?

2010-03-25T21:05:00.001-05:00

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

Many providers have asked whether they should modify their business associate agreements to comply with the HITECH Act. There is, in fact, ongoing discussion and debate in the legal community about this issue. It seems fair to say that business associate agreements should be modified to comply with requirements of the HITECH Act regarding notification of breaches, since final regulations have been published implementing these requirements.

On August 19, 2009, the Department of Health and Human Services (HHS) issued an interim final rule entitled “Breach Notification for Unsecured Protected Health Information.” This rule describes how healthcare providers must notify patients when the security of their protected health information has been breached. Providers were required to comply with these new requirements beginning on September 23, 2009. Providers are also required to revise their internal policies to include these requirements.

According to HHS, a breach occurs when protected health information is acquired, accessed, used, or disclosed in a way that poses “significant risk of financial, reputational, or other harm to the individual.” Breaches involve access to a patient’s information by unauthorized persons, except when providers or employees disclose information in good faith to unauthorized persons based upon the belief that such persons are unable to retain this information.

HHS states that breach notification must include:

1. A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known;

2. A description of the types of unsecured [emphasis added] protected health information that were involved in the breach (such as whether full name, social security number, date of birth, home address, account number, diagnosis, disability code, or other types of information were involved);

3. Any steps individuals should take to protect themselves from potential harm resulting from the breach;

4. A brief description of what is being done to investigate the breach, to mitigate harm to individuals, and to protect against any further breaches; and

5. Contact procedures for individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an e-mail address, Web site, or postal address.

Implementation of HIPAA has been cumbersome for many providers. It is likely to continue to be problematic in terms of understanding what is required and when it is required.

No portion of these materials may be reproduced by any means without the advance written permission of the author.

Decision Health Home Health Coding Summit 2010 Sponsor

2010-03-23T15:35:00.000-05:00

Daymarck is proud to be the title sponsor of the 2010 Decision Health Home Care Coding Summit, August 8-12 in Philadelphia. We hope to see you there as we share our learnings from the past year, collaborate with other home care leaders, and demonstrate how we can make your home care coding as pain free as possible.

Philadelphia is a fantastic city and we look forward to seeing you there.

Guest Post: Patients’ Right to Freedom of Choice of Hospices in Hospitals

2010-03-02T16:21:00.001-06:00

Patients’ Right to Freedom of Choice of Hospices in Hospitals

Elizabeth E. Hogue, Esq.

Office: 877-871-4062

Fax: 877-871-9739

E-mail: ElizabethHogue@ElizabethHogue.net

All providers are required to abide by patients' right to freedom of choice. There are a number of sources of this right as follows:

1) All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. Thus, when patients voluntarily express preferences for providers, their choices must be honored, regardless of payor source, level of care, or type of treatment.

2) Federal statutes of the Medicare and Medicaid Programs guarantee Medicare beneficiaries and Medicaid recipients the right to freedom of choice of providers. When Medicare and Medicaid patients voluntarily express preferences for post-acute providers of all types, these choices must be honored.

3) The Balanced Budget Act of 1997 (BBA) requires hospitals to develop a list of home health agencies and SNF’s, not hospices. The list of home health providers must include agencies that:

a. Are Medicare certified;

b. Provide services in the geographic areas where patients reside; and

c. Ask to be on the list.

In addition, if hospitals place the names of agencies in which they have a discloseable financial interest on the list, the relationship between the hospital and the agency must be disclosed on the list.

This list must be presented to all patients who may benefit from home health services so that they can choose agencies they wish to provide services to them.

4) Hospital Conditions of Participation (COP's) include the basic requirements of the BBA described above.

Based upon the above, hospitals are required to honor patients’ choices of hospices if they voluntarily express them. Hospitals are not required to offer patients choices of hospices, including lists of hospices. Some hospitals, however, voluntarily use lists of hospices even though they are not required to do so. If hospitals do so, hospices should make certain that their names appear on such lists.

Practitioners who have reviewed survey guidelines published by the Centers for Medicare and Medicaid Services (CMS) may note the following language:

…we expect hospitals to provide a list of Hospice [emphasis added], HHA’s or SNF’s that are available to patients, that participate in the Medicare program, and that serve the geographic area that the patient requests.

Survey guidelines, however, cannot be enforced by CMS like the statutes and regulations describe above. Hospitals are not legally required, therefore, to present lists of hospices to patients as they are required to do for both home health agencies and SNF’s. But hospitals may be wise to do so in order to avoid Statements of Deficiency if they are surveyed by state survey agencies.

The hospice industry has changed dramatically. The competition for patients is fierce. Hospices should use all of the tools available to them in order to compete. Hospital discharge planners/case managers have an obligation to protect patients’ rights regardless of legal requirements.

No portion of these materials may be reproduced in any form without the advance written permission of the author.