December 4, 2016

Sometimes OASIS doesn’t mean what it says…

I know it comes as a surprise to some of you, but the government isn’t always clear with its instructions [tongue in cheek]. Take M1060 for example:

Do you see that first line regarding the weight? It states “Base weight on most recent measure in last 30 days…” That seems great to a lot of folks who think that ‘we will not have to get that patient weighed after all,’ for example, that patient that was weighed via the scale on the Hoyer lift, or that patient who does not have a set of scales and you forgot to bring yours. Do you think you can just review that hospital or SNF record looking for a weight and enter that one?

Sometimes OASIS doesn’t mean what it says. That first line “Base weight on most recent measure in last 30 days…” doesn’t really mean a thing. See the guidance below. I’ve emphasized the important part.

Q62.9.M1060. For the new OASIS item M1060, can the agency gather the patient’s height and weight by patient/caregiver report? M1060a requests most recent height measure since SOC/ROC, but M1060b allows most recent weight measurement in last 30 days. So does that mean that height must be actually measured after the home health admission, but weight can be entered based on hospital discharge paperwork documented within the last 30 days? Can we ask the patient or caregiver the patient’s height and/or weight? [Q&A ADDED 10/16; Previously CMS Qtrly 10/16 Q&A 10]

A62.9. The assessing clinician should measure the patient’s height and weight in accordance with the agency’s policies and procedures, which should reflect current standards of practice (shoes off, etc.). The assessing clinician is expected to weigh and measure the patient as part of the comprehensive assessment. Data collection for M1060 by self-report or from paperwork from another provider setting is not acceptable. If a patient cannot be weighed/measured, enter the dash value (“-“) and document the rationale on the patient’s medical record. A dash (–) value indicates that no information is available and /or an item could not be assessed. CMS expects dash use to be a rare occurrence.

Q62.9.1.M1060. For the new OASIS item M1060, can the agency gather the patient’s height and weight by patient/caregiver report? M1060a requests most recent height measure since SOC/ROC, but M1060b allows most recent weight measurement in last 30 days. So does that mean that height must be actually measured after the home health admission, but weight can be entered based on hospital discharge paperwork documented within the last 30 days? Can we ask the patient or caregiver the patient’s height and/or weight? [Q&A ADDED 10/16; Previously CMS Qtrly 10/16 Q&A 11]

A62.9.1. The assessing clinician should measure the patient’s height and weight in accordance with the agency’s policies and procedures, which should reflect current standards of practice (shoes off, etc.). The assessing clinician is expected to weigh and measure the patient as part of the comprehensive assessment. Data collection for M1060 by self-report or from paperwork from another provider setting is not acceptable. If a patient cannot be weighed/measured, enter the dash value (“-“) and document the rationale on the patient’s medical record. A dash (–) value indicates that no information is available and /or an item could not be assessed. CMS expects dash use to be a rare occurrence.

 

For complete, comprehensive training on OASIS-C2, attend one of Selman-Holman on-site conferences (see www.selmanholman.com/seminars  or on-line training found at www.med-PASS.com.

November 30, 2016

Gratitude IS Our Attitude

As the month of November draws to a close, the Thanksgiving leftovers slowly dwindle down, we pause in reflection.  It’s not just a cliché…we really do have so much to be thankful about!  With the holidays upon us and the year nearing the end, we are grateful for the opportunities that Selman-Holman & Associates, LLC and CoDR—Coding Done Right have been given.  We are always striving to provide insightful materials and tools used for the home health market.  Our team works vigorously to provide breaking news and share poignant information to our clients.  We are truly grateful to those who utilize our services, read our blogs, attend our seminars, and enroll in CodePro University.

This is our humble way of saying thank YOU!

November 11, 2016

Thank You Veterans!

I pledge allegiance to the flag of the United States of America.

And to the Republic, for which it stands, one nation, under God, indivisible, with liberty and justice for all.

We are indebted to the great veterans of our country for volunteering to serve and protect this pledge.

As we embark on a new presidency and certain changes for our nation, Veterans Day is the perfect time to pay homage to those who are willing to serve regardless who is in the Oval Office. Our military members do not see red or blue states. They simply respect the entirety of the Red White and Blue, and are willing to pledge their life to defending her.

We have much to learn from these exceptional individuals. They did not fight for us based on the color of our skin, educational backgrounds or religious affiliation. Their oath is a blanket that encompasses all Americans.

It goes without saying, the immense sacrifices they endure to serve our country. Sacrifices most of us are not willing to make. So when you see a service member, retired or active, please take a moment to thank them for making the choice to defend us through immeasurable cost to themselves and their families.

God Bless America.

October 5, 2016

Breaking News From HCAF

hcaf-news

CLICK HERE to take action NOW!

Today, CMS released a small amount claims data from the ongoing Pre-Claim Review (PCR) Demonstration in Illinois.

Some items of note in the Illinois data:

  • As of week 8, 66% of PCR requests have received a provisional affirmation or partially affirmed decision.
  • As of week 8, the non-affirmation rate is 34%.
  • Click here to read all of the data and more PCR resources on HCAF’s website
Additionally, CMS indicates the top reasons for non-affirmation:
non-affirmation
HCAF is working with our national partners and state associations to request more data through the Freedom of Information Act (FOIA). A FOIA request will help us gain far more data that providers, lawmakers and CMS need in order to truly know if the PCR Demonstration project is actually effective. PCR is absolutely not realistic in its current untargeted scope and more data will help us paint a better picture of the program’s future viability.

PCR began in Illinois on August 3, 2016. After our advocacy efforts, CMS earlier announced that they will not move forward with initiating the demonstration in Florida in October, but still continued with the program in Illinois.

We are sharing this data with Florida providers because this will help you prepare. PCR is delayed in our state but it’s not going away for good! CMS plans to release education on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation until they are ready to re-launch the program. CMS will undoubtedly move forward with PCR in Florida and will provide at least 30 days’ notice on their website prior to the beginning date. CMS has said that Florida will be the first state to start when they re-launch the program. 30 days is not enough time to prepare so please use this data coming out of Illinois to start re-organizing your agencies to ensure high affirmation rates when Pre-Claim Review does in fact come to our state.

We continue to advocate against Pre-Claim Review and we need your help to delay this program even longer and have a chance to permanently get rid of PCR. There is now legislation in the U.S. House of Representatives that would impose a 1 year delay. We need Florida lawmakers to sign-on as co-sponsors. Visit our Legislative Action Center to help us end PCR once and for all by writing to your lawmakers today! CLICK HERE to take action NOW!

**All content and images are credited and attributed to the Home Care Association of Florida.
August 25, 2016

The Flexibility Conundrum

INDUSTRY & AHIMA NEWS:

CMS FAQ Update Reminds Providers: ICD-10 Flexibilities End October 1.
In a recent FAQ update, the Centers for Medicare and Medicaid Services (CMS) reminds providers: Flexibilities regarding the specificity of ICD-10-CM codes on Medicare physician/practitioner claims will come to an end on October 1. Last summer, CMS announced that for 12 months after the October 1, 2015, ICD-10 implementation, Medicare review contractors would not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated or complex medical record review based solely on the specificity of the ICD-10-CM diagnosis code, as long as the physician/practitioner used a valid code from the right family of codes.

The update also indicated that providers should already be coding to the highest level of specificity. Even with the ICD-10-CM flexibilities, a valid ICD-10-CM code has been required on all claims for dates of service on or after October 1, 2015. In addition, while unspecified ICD-10-CM codes should be avoided whenever documentation supports a more detailed code, unspecified codes are allowed because they have acceptable, even necessary, uses.

Although the “flexibility” period only applied to physicians, hopefully there will be a trickle down effect with documentation. We can only hope.