More than checking a box

I’m working on a lot of audits—responding to ADRs and requests for redeterminations these days—both probe edits and ZPICs. One of the many things I’m noticing about documentation is the non-support of homebound status.

We check boxes such as “considerable and taxing effort” and “requires assistive device” but there is little documentation to support WHY there is a considerable and taxing effort and WHY an assistive device is required. Homebound is based on the patient’s illness or injury that is creating a taxing effort to leave home.

The Medicare Benefit Policy Manual Chapter 7 30.1.1 states: “Generally speaking, a patient will be considered to be homebound if they have a condition due to an illness or injury that restricts their ability to leave their place of residence except with the aid of: supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated. [emphasis added] The condition that creates the homebound status needs to be clearly documented.”

Don’t just check a box and move on!! If you need any assist in responding to probe edits or ZPIC redeterminations, we are standing by to assist. The process takes time and after preparing the documentation for you we can provide targeted education to your staff to get you on the right path.

Leave a Reply

%d bloggers like this: