A Lisa Selman-Holman blog
The Home Health Quality Improvement Cross Settings Best Practice Intervention Package (BPIP) series has begun. The first in a series of three dealing with best practice education, this one on cross settings, was published on October 28th and is currently available on the HHQI Web site at www.homehealthquality.org.
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I posted late Tuesday on clinicians doing a skilled visit and the comprehensive assessment. I’ve received several requests for an example, so here you go!
A referral on a patient requires a visit at 10pm to administer an IV antibiotic. An RN can make the visit at 10pm, providing the skillled care and performing the initial assessment (determine immediate care needs and homebound status). That visit qualifies as the SOC because a reimbursable service was provided. Another RN can make a visit the next day (or within 5 days after the SOC) to complete the OASIS comprehensive assessment.
The home health PPS final rule for 2011 is out, and the result is lower episodic rates than in 2010. The base rate will be between $2,312.94 to $2,192.07 — depending on the wage index where your HHA is located. This base is a reduction of $120.87 or 5.22%.
The National Association for Home Care and Hospice created this graphic to show the breakout of the payment calculation:
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There are still different base rates for rural vs. non-rural areas.
LUPA payments have a different calculation, which does not use the 3.79% case-mix weight change adjustment. Again, from NAHC, the per-visit rates are as follow:
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Non-routine medical supplies (NRS) are paid under a separate case-mix adjustment model. The NRS payment amounts are as follows:
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The examples above are just that. There are many other factors, such as whether an HHA has or has not submitted quality data, that can influence payment.
It seems that many agencies believe that the SOC OASIS needs to be done by the same clinician who did the first visit, but that’s not true.
The initial assessment does not have to done by the same person who does the comprehensive assessment. Most times, it is the same person because both assessments are completed during the same visit, but the CoPs allow for the initial assessment being performed at a different visit.
Remember that if nursing is involved in the POC, an RN must conduct both assessments. In some instances, it may be a therapy only case, the therapist may complete the initial assessment and the RN may visit on the same day or within five days after the therapist’s visit to complete the comprehensive assessment.
