NAHC Report: Diagnosis Coding Changes Proposed in 2013 PPS Notice Carry Negative Impact

At Daymarck, we are pleased that the National Association for Home Care and Hospice (NAHC) is also concerned about CMS' proposed prohibition of reporting any diagnosis codes other than fracture codes in OASIS at M1024. The NAHC Report Article published on Aug. 21 (and attached below) discusses their concerns and urges home health agencies to evaluate the impact of these proposed changes.

According to William Dombi, Vice President for Law at NAHC, "The proposal may affect two to four percent of episodes as much as $200 per episode. That is a material impact that should require CMS to drop this idea or recalibrate all the case mix weights to make sure the change is budget neutral."

We are are pleased to offer a reprint of the article below.  Read what Daymarck has to say on this important issue, including our public comment to CMS.

NAHC Report Article

Issue# 2026, 8/21/2012

Diagnosis Coding Changes Proposed in 2013 PPS Notice Carry Negative Impact
NAHC Urges Agencies to Review the Rule Change

In the 2013 Prospective Payment System (PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) revealed a plan that would result in the prohibition of reporting any diagnosis codes other than fracture codes in OASIS at M1024.

In the July 13 Federal Register notice, CMS stated that when they updated and released Attachment D: Selection and Assignment of OASIS Diagnoses in December 2008 “this guidance was designed to ensure that providers limited the number of diagnoses assigned to M1024.” M1024 replaced M0245 in OASIS C. M0245 was the OASIS data field created to record case-mix diagnoses ICD-9 Coding rules required that V codes be used in primary and secondary diagnoses in order to ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) requirements. According to CMS, an analysis of home health claims found that many home health agencies don’t comply with Attachment D guidance.

CMS Position

According to Attachment D, home health agencies are limited to reporting Fracture, Diabetes, Neuro 1 and Skin 1 codes in M1024. However, Diabetes, Skin 1, and Neuro 1 codes may be reported in M1010 and M1020. Fracture codes are the only codes that may not be reported as primary or secondary diagnosis. As a result, CMS has proposed two enhancements for the HH PPS Grouper:

Restrict M1024 to only permit fracture (V-code) diagnoses codes which according to ICD-9-CM coding guidelines cannot be reported in a home health setting as a primary or secondary diagnosis.
Pair the fracture codes (V-code) with appropriate diagnosis codes to limit the award of grouper points only when these pairings appear in the primary and payment diagnosis fields.

Revise the HHRG logic to permit equivalent scoring when the Diabetes, Skin 1 or Neuro 1 codes are submitted immediately following the V-code in the M1020 position without requiring utilization of the payment diagnosis field.

Shortcomings of CMS Proposal

In its efforts to update the HH PPS case-mix system, CMS had its contractor analyze home health claims and OASIS data from the first five years of the PPS to determine whether the case-mix system required revisions. As a result of this analysis the original diagnostic categories of Diabetes, Neuro, Ortho and Skin were expanded, and several new diagnostic categories were added that included: blindness, blood disorders, cancers, gastrointestinal disorders, heart disease, and hypertension. The data analyzed led to the determination that these additional diagnostic conditions were indicators of home health resource utilization. Much of the information about the impact of these diagnoses on resource utilization was collected from the period of time prior to the implementation of the HIPAA. Therefore, the diagnoses were reflective of coding practices at that time, including the reporting of conditions that were resolved by surgery or recovery, but for which home health patients received aftercare.

For example, such gastrointestinal disorders, as acute appendicitis and cholelithiasis are never conditions for which a Medicare beneficiary would receive home health services. However, prior to HIPAA and the establishment of M0245, and even into 2004, reporting of conditions resolved by surgery as primary and secondary diagnoses was the longstanding practice of home health agencies providing post-surgical care.

These CMS proposed changes to the HHRG will deprive home health agencies of case-mix points and payment for services for care to patients whose conditions are resolved by surgery, disregarding the fact that these diagnoses were found to impact resource use. Included are the majority of gastrointestinal conditions, cancers and orthopedic conditions treated by surgery as well as resolved infections that require post-acute care in the home for (e.g. meningitis). Furthermore, prohibiting reporting of diagnoses that require V code reporting in the primary and secondary fields in OASIS M1024 will eliminate all vehicles for capturing important public health and health planning data sources about underlying medical conditions that require post-acute home health services.

The National Association for Home Care & Hospice (NAHC) has identified a vast array of diagnoses that will no longer be eligible for case-mix points if removed by surgery, including conditions in the following ICD-9 categories: 140-199, 213-234, 320-329, 414, 440,530-562, 564-567, 569 and 570, 574-577, 685, 707, 711, 713, 715 and 716, 720-724, 726 and 727, 730, 731, 733, 741, 785, and 831-838.

NAHC urges home health agencies to evaluate the impact of these proposed changes. To learn more about this proposal and other proposed rule changes and payment updates for 2013 the Federal Register notice can be accessed at http://www.gpo.gov/fdsys/pkg/FR-2012-07-13/pdf/2012-16836.pdf. Comments about this proposal and other changes to home health regulations (F2F encounter, therapy reassessment requirements) must be submitted to CMS by 5PM on September 4, 2012.

Its Almost Time for the Annual NAHC Financial Management Conference: July 15-17 in Dallas, TX

We can’t believe its already time for the NAHC Financial Management Conference; where has the first half of the year gone?

If you’re attending this year’s show in Dallas, Texas July 15-17th, we hope you’ll take a minute (or two) to stop by our booth (#304). We’ll be giving out free Custom Coding Cost Analysis’s to show how you can improve efficiencies and your bottom line. Our analysis will include how ICD-10 will influence your organization’s productivity and bottom line. For a more in-depth analysis of your coding expenses and efficiency recommendations, please email Carie Wright for a specific meeting time.

We understand folks are uncertain about how their organizations will adapt to regulatory changes like ICD-10, and we know it’s becoming harder and harder to stay profitable. That is where our team can help. Our goal for this event is to help attendees improve their bottom line by making home healthcare coding as pain-free as possible.

For those attending, we look forward to seeing you in Dallas and discussing how using a professional coding team can save your organization money while remaining 100% compliant. And if you can’t make it, stay tuned here and on Facebook or Twitter for updates during and post-show.

Are your vendors prepared for ICD-10?

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.

How will ICD-10 affect productivity?

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.

Myth Dispelled: ObamaCare ≠ ICD-10

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

ICD-Survey: The Results Are In

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

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! 

NAHC Wrap-Up

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.

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

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.

NAHC Calls Selected Agencies to Participate in an Important Survey

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.  

Home Care, Hospice Community Urged to Ramp Up Grassroots Campaign

Participate in Action To Protect Home Care and Hospice!

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

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

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

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

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

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

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

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

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

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

Daymarck Update: August 2011

By Daymarck CEO Nick Dobrzelecki

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

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

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

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

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

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

Survey Results: Home Health Face-to-Face Requirements

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:

1. The patient's name;
2. Date of the encounter;
3. How the patient's clinical condition as seen during the encounter supports homebound status and the need for skilled services;
4. The physician's signature (original signature, a faxed copy, copy of original document with signature or electronic signature - but not stamped signature); and
5. 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

By Nick Dobrzelecki RN, BSN
Daymarck CEO

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

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

The reasons for this challenge to homecare agencies include: 

1. The documentation from the providers have to be in their words. Agencies can create forms, however, they are not to use pre-populated fields such as check boxes. This is especially challenging when the provider has to document why the patient is homebound. The vast majority of providers do not understand the CMS definition and the significant importance that CMS puts on the homecare agency to document this. 
2. Many providers are already faced with additional requirements and with lower reimbursement to achieve them. Agencies are getting significant push back from providers to complete these forms. Providers are asking for the agency to complete the form so that the provider can just sign off. The regulation specifically does not allow this. So some providers are just refusing to complete this documentation. Agencies then have to discharge the patient from services. Regulation specifically exempts the patient from financial liability if the documentation is not complete. The agency cannot bill for any services provided.

The National Association for Home Care (NAHC) has been working to get this regulation modified and they need your assistance. They are collecting statistics and feedback from providers. Will you help by taking the survey or passing it along to a physician group?

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

Thanks in advance for your help.

Daymarck: Report on Our Progress

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.

Great Opening Night at NAHC 2010

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.

Action Alert :

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.

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

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.

What Agencies Must Do to Survive

Home Care Leadership: What Agencies Must Do to Survive
By: Nick Dobrzelecki, Founder and Chief Executive Officer, Daymarck
January 2010

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.

For many agencies, the new rules and guidelines can seem daunting. Recently, the Centers for Medicare & Medicaid Services released the Final Rule updating the policies and rates associated with the Medicare home health prospective payment system (HH-PPS) for calendar year (CY) 2010.  In addition, the Department of Health and Human Services' Office of the Inspector General (OIG) has released its Work Plan for the fiscal year 2010, describing the areas and issues that the OIG will audit, evaluate and inspect in the coming year.

Home Health Code Pro Software at NAHC 2009

While at the 2009 National Association for Home Care Expo in Los Angeles, Daymarck announced how its Home Health Code Pro software helps providers improve compliance and accuracy. Read the press release in the Daymarck News/Events section of their web site.