Archive for May, 2012

May 29, 2012

Education: Some vision resources

More and more our patients and their families want resource information, and we should provide it, if we can, rather than have them Googling for answers.

We’re nearing the end of healthy vision month. The Centers for Disease Control and Prevention has released, or updated, a large number of publications aimed at vision education. With so many of our patients affected by loss of vision due to age or disease, this can be quite useful for families and caregivers.

Information here provides studies and other information on everything from access to care to vision rehabilitation to costs studies.

CDC’s Vision Health Initiative

May 25, 2012

Denials begin for PoC without physician approval

The National Association for Home Care & Hospice (NAHC) recently learned that home health agencies have begun to receive Medicare denials because they provide services and treatments in accord with a plan of care developed after assessing the patient, without obtaining prior approval from the physician for the treatments and services in the plan. In these cases, nurses and therapists conduct patient assessments, initiate care in accord with the referral and create a written plan of care based on assessed needs. They then mail or fax this plan of care to the physician without first receiving approval from the physician for visits and treatments included in the plan of care.

As a result, services that were provided after the initial visit and up to the date of the physician’s signature on the plan of care are denied for lack of physician orders.

The Conditions of Participation (CoP) at 42 CFR 484.18(a) requires that the plan of care be developed in consultation with the agency staff, and that the physician be consulted to approve additions or modifications to the original plan. Further, the CoP require that therapy services include the specific procedures and modalities to be used and the amount, frequency, and duration.

The Medicare coverage rules at 42 CFR § 409.43 specify that the plan of care must contain those items listed in the CoP at 42CFR §484.18(a) and that physician’s orders for services in the plan of care must specify the medical treatments to be furnished as well as the type of home health disciplines that will furnish the ordered services and at what frequency the services will be furnished.

See the Medicare Benefit Policy Manual ( for more specific information, including guidance on oral orders.

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May 24, 2012

SNOMED and ICD-10 … happy together?

Recently two groups: The American College of Physicians and the Texas Medical Association, advocated using SNOMED, the Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT).

ACP actually advocates a 2014 implementation for ICD-10 and wants to see if the codes can be automated from SNOMED.

TMA would like ICD-10 scrapped and replaced either with SNOMED-CT or ICD-11.

Read the ACP letter to HHS
Read the TMA letter

May 11, 2012

WOCN library helps walk us through wound issues

WOCN has moved its library to a new web address.

On this page you can find guidance for pressure ulcer staging, avoidable and unavoidable pressure ulcers, management of chronic wounds, guidance on ostomy and continence issues, and much more.

May 8, 2012

ICD-10 comment period to close soon

Just a reminder that the comment period on potentially delaying ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, closes May 17 at 5pm EDT.

See the proposed rule.

Get your comments in:

Electronically by following the ‘‘Submit a comment’’ instructions on the

By regular mail:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013