Archive for December, 2014

December 18, 2014

ICD-10 IS Coming! Your First Steps

The ICD-10 delay that select physician groups tried to sneak into the “Cromnibus Bill” was not successful, so thus far ICD-10 will be implemented October 1, 2015. That means, for home health agencies, episodes beginning August 3rd will need to be dual coded—ICD-9 for the RAP and ICD-10 for the end of episode. Hospice benefit periods will also need special attention during the transition.

Selman-Holman, along with CoDR—Coding Done Right and CodePro University are your best choices to assist you with education, consulting and coding services so you can be ready for the transition to ICD-10.

Not quite ready to begin your education regarding ICD-10 coding? Available now: Great online education regarding home health and hospice documentation that will improve your chances of withstanding medical review, and anatomy and physiology to strengthen your clinicians’ understanding.

The following article is from the NAHC Report December 18, 2014 and provides information regarding the next end-to-end testing. Selman-Holman can assist  you so that you can test your claims early so that you will be ready for ICD-10.

Volunteer for ICD-10 End-to-End Testing in April — Forms Due January 9

During the week of April 26 through May1, 2015, a second sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The goal of end-to-end testing is to demonstrate that:

  • Providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For Service (FFS) claims systems
  • CMS software changes made to support ICD-10 result in appropriately adjudicated claims
  • Accurate remittance advices are produced

Approximately 850 volunteer submitters will be selected to participate in the April end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January testing are able to test again in April and July without re-applying.

To volunteer as a testing submitter:

  • Volunteer forms are available on your MAC website.
  • Completed volunteer forms are due January 9.
  • CMS will review applications and select the group of testing submitters.
  • By January 30, the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing.

 For more information:

  • MLN Matters® Special Edition Article #SE1409, “Medicare FFS ICD-10 Testing Approach”
  • MLN Matters® Special Edition Article #SE1435, “FAQs – ICD-10 End-to-End Testing”


Visit: for upcoming live sessions on ICD10 being scheduled now for online education opportunities for information on OASIS review, home health and hospice coding services

December 10, 2014

What’s Your Process for Verification of Licenses?

What’s Your Process for Verification of Licenses?
This article from the OIG was timely as it reminded me that it is December and my nursing license is due for renewal this month.
How does your agency/hospice check the identification and licensure status of your clinicians? I’ve had calls in recent history from agencies looking for advice when they’ve recently determined that the nurse making visits had let his/her license lapse. One nurse accidentally transposed the numbers on her debit card so her license was not renewed due to non-sufficient funds. Imagine her surprise!

Hospice and Home Health CoPs require that state laws regarding licensure are followed. All visits, including any OASIS assessments, completed by that particular nurse are not billable and the OASIS assessment is invalid. Take a look at what a mess these hospices have on their hands after a “RN” was hired that actually was NOT an RN.

December 9, 2014
DALLAS — A Dallas woman who stole the identity of a registered nurse and used that identity to work at several Dallas-Fort Worth (DFW) area hospice companies, appeared in court this morning before U.S. Magistrate Judge David L. Horan, and pleaded guilty to a federal offense stemming from that conduct, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Jada Necole Antoine, 33, pleaded guilty to one count of fraud in connection with means of identification. She faces a maximum statutory penalty of 15 years in federal prison, a $250,000 fine and restitution. Antoine has been in custody since her arrest this past summer in Georgia on a related criminal complaint filed in May 2014 in the Northern District of Texas. She is scheduled to be sentenced on March 16, 2015.
According to documents filed in the case, Antoine, who was not licensed as a physician, registered nurse, or other health care provider, stole a registered nurse’s driver’s license and social security card, and used that victim’s driver’s license, social security number, and other means of identification to obtain employment at eight different hospice companies in the DFW area, including Heart to Heart Hospice of Texas, Odyssey Healthcare GP, LLC, Community Hospice of Texas, Elysian Hospice, Hospice Pharmacy Solutions, New Century Hospice, Keystone Custom Care Hospice, and Silverado Senior Living Hospice.
Having fraudulently obtained employment as a registered nurse at Heart to Heart and Odyssey, Antoine had direct responsibility for patient care. She submitted documents to Heart to Heart and Odyssey that falsely indicated that care was provided to patients under her supervision by a registered nurse, namely the registered nurse whose identification she had stolen.
Antoine’s false statements, theft of the victim’s identity, and other fraudulent activity caused Heart to Heart, Odyssey and other hospice agencies to submit false claims for, and obtain reimbursement from, Medicare and Medicaid for hospice services provided to Medicare beneficiaries and Medicaid clients. From approximately January 2009 through April 20, 2012, approximately $2.3 million in hospice claims were submitted to Medicare for services purportedly performed by Antoine while she was impersonating the victim registered nurse.
Antoine received compensation of $5,077 from Heart to Heart and $49,851 from Odyssey.
The FBI, Department of Health and Human Services Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit investigated. Special Assistant U.S. Attorney Douglas Brasher is in charge of the prosecution.