December 5, 2011
It’s not too late to sign up for my OASIS: Strategies for Success seminars!
We’re touring in:
Dec. 5-6: Houston
Dec. 13-14: Dallas
This is beyond basics. Here are some highlights of what we will focus on:
- What OASIS is used for, and why accurate and consistent assessment really matters
- How to score OASIS items on a Start of Care assessment
- Techniques to improve assessment accuracy and speed
- How responses to individual OASIS items impact your agency’s reimbursement, OBQI outcome scores, and OBQM avoidable events
- How the new risk adjustment model works, and how your clinicians’ OASIS responses shape your agency’s case mix profile and outcomes
- How to put all the pieces together to improve care delivery and quality outcomes
Learn more and register!
November 14, 2011
CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.
“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”
Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.
Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.
However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).
Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!
July 5, 2011
The calendar year 2012 home health proposed rule is proposing a few changes that could greatly affect payment to HHAs:
- 401.1 and 401.9 may be removed from the case-mix list. CMS has done a series of analyses on use of the codes and resource use. The agency proposes removing these to more accurately align resources and payment use.
- Lowering payments on high therapy episodes
- Adjusting case-mix weights
More to come soon …
July 5, 2011
A proposed rule in the Federal Register on Tuesday proposes a 3.35 percent decrease in Medicare payments to HHAs for calendar year 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011. It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the HHPPS rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to changes in the health status of patients (a $950 million decrease).
Provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent update for HHAs next year. As part of the HH PPS rate update, CMS also proposes to reduce HH PPS rates by 5.06 percent in CY 2012 to account for the increase in the case-mix that is unrelated to changes in patient acuity.
The Medicare HHA proposed rule would also make structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.
The proposed home health market basket increase for CY 2012 is 1.5 percent. HHAs that submit the required quality data would receive payments based on this full home health market basket update. If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.5 percent for CY 2012.
See the proposed rule.
April 26, 2011
Question: Let’s say that I did a recert on 4/11/2011 and then the patient had an outpatient mastectomy 4/12/2011. I went to see her on 4/13/2011, which was the first day of her recert. Would this visit be considered a SCIC or can we do as a regular visit and a telephone order for the orders of the mastectomy care?
Lisa says: A follow-up assessment is required for a major improvement or decline in condition, but your policy defines major improvement or decline. You must complete another follow-up assessment if the circumstances meet your policy.
April 18, 2011
ICD-10 seems so far away, and we shouldn’t learn specific coding information until it gets closer to transition time. However, knowing the basics of ICD-10 and what will change can be useful for us all.
AHIMA has begun to run educational overviews on ICD-10 codes. This month’s education focuses on the musculoskeletal system.
ICD-10 addresses the musculoskeletal system in Chapter 13: Disease of the Musculoskeletal and Connective Tissue (M00-M99) and Chapter 19: Injury, Poisoning, and Certain Consequences of External Causes (S00-T88) (to replace current Chapter 17 items).
These chapters identify the episode of care, give more specifics on fractures and injuries and add osteoporosis instructions.
See this month’s on the musculoskeletal system, which also includes specifics on:
- site and laterality;
- moved codes;
- injuries and fractures;
April 5, 2011
Question: Does the therapy count start over if a patient is admitted to the hospital? Since new therapy evaluations are completed after the post-hospital visit (resumption of care), would a new count begin at this point?
Lisa says:This has to do with the number of therapy visits per episode. The count does not start over after a hospitalization unless you’re in a new episode.
March 16, 2011
Question: What G-code would be used for initial patient admission into a HHA? Patient is discharged from hospital with CHF exacerbation, new meds. SN does complete assessment, reviews all new and continued medications, medication and disease process teaching, etc., and completes the OASIS, 485, etc.
Lisa says: Assign the G code that reflects what was most important about the visit remembering that the OASIS assessment is not, by itself, billable.
January 30, 2011
Does any of this sound familiar?
What do I do when:
- A patient in a new 60-day episode is discharged with all goals
met but the patient returns to the same HHA during the 60-day episode. (PEP Adjustment applies)
- I have a patient with a qualifying inpatient stay who returns to the agency during the last 5 days of an episode (days 56-60).
- My patient’s inpatient stay extends beyond the end of the current certification period. … and other such timing and care quandries?
CMS released in December and just recently updated its OASIS Considerations for PPS. This document deals with common problems, which RFA to work with, how to think about M0100 and M2200, and also has links to the Claims manual where you can find more information.
It is worth more than one look!
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January 26, 2011
The CDC just came out with new figures on diabetes in the United States:
More than 26 million Americans now have the disease, and about one-third of adults have prediabetes.
Check out the CDC page.