Posts tagged ‘HHA’

December 2, 2012

HHQI releases best practices on patient self-management

Selman-Holman Associates is a coordinator with this, and it is exciting! HHQI now has released its Best Practice Intervention Package on patient self-management.

Are you familiar with your community’s efforts to improve the 30-day readmission rates of patients to your local facilities? Most communities around the country are addressing this issue in one form or another. Have you been contacted by someone in your community to discuss this issue? If not, you may want to ask yourself, ‘why not?’

As we all know, home health plays a central role in helping patients regain their health and remain in their homes. If you are not currently ‘at the table’ for your community discussions, now is the time to contact other providers –other home health agencies as well as hospitals, nursing homes, SNFs and physician offices – and begin the discussion as to what you can do as a community to improve the quality of care you provide to your citizens as they move from one care setting to another.

The Home Health Quality Improvement (HHQI) national campaign recently released the focused Best Practice Intervention Package (BPIP) on the topic of Patient Self-Management. This BPIP is much smaller than the previous packages updating the content published in 2011.

If you haven’t downloaded it yet, please do so and share with your community partners. To download this, please go to the HHQI website and either register or login.

The BPIPs are found under the “Education” tab on the blue tool bar.

November 16, 2012

Nephrostomy tubes are response 2 on M1018

A clarification from CMS on M1018 and nephrostomy tubes …

Question: When answering M1018, if client has a nephrostomy tube do you mark indwelling/suprapubic catheter?
Answer from CMS: If the nephrostomy tube is utilized for urinary drainage, it is an indwelling
catheter, therefore Response 2 – Indwelling/suprapubic catheter would be selected.
See more Q&As.

November 11, 2012

Once again: 401.9 is a valid code

I have received another email from someone who attended my class asking me to verify that 401.9 is a valid code … others at her agency are telling her that it is not a valid hypertension code.

It is. 401.9 is valid. It is a useful code and one that you may have to use, depending on documentation.

401.9 is a valid code and is the correct code for HTN when no other information is available. It would be upcoding to change your hypertension code if you did not have additional information. There are many codes that we use that do not provide points, and this code is no longer case-mix. We must code according to the patient’s condition and the coding guidelines regardless whether the code is case-mix. Remember that if the patient has a heart condition, such as acute MI, chronic insufficiency, CAD or heart failure, then you’ve still earned those points that used to be awarded for 401.9.

October 15, 2012

TX HHA owner pleads guilty to $374 million in fraud

From the Northern District of Texas ….

A Dallas-area home health services company owner admitted his role in a $374 million home health fraud scheme in which he and others conspired to bill Medicare for unnecessary services that were never performed. Cyprian Akamnonu, 64, of Arlington, Texas, entered his guilty plea to one count of conspiracy to commit health care fraud before U.S. District Judge Sam A. Lindsay in Dallas federal court.

According to court documents, beginning in at least January 2006, Akamnonu, along with his wife Pat Akamnonu, owned and operated Ultimate Care Home Health Services, Inc. Cyprian Akamnonu admitted that he directed his wife and others to recruit Medicare beneficiaries from Dallas neighborhoods for home health services they did not need and for which they did not qualify. Once the beneficiaries were recruited, Cyprian Akamnonu would take prescriptions for home health services to the offices of Medistat Group Associates, P.A., owned and operated by co-defendant Jacques Roy, M.D.

See the whole release from the Department of Justice

October 14, 2012

OIG FY2013 work plan is out

The Office of the Inspector General work plan for home health agencies (and all providers) was just released. As usual, OIG is telling us exactly what we need to pay attention for the upcoming fiscal year, starting Oct. 1, 2013. The highlights are below:

Face-to-Face Requirement: OIG wants to see how well HHAs are complying with new F2F requirements.F2F encounters must occur within 120 days: either within the 90 days before beneficiaries start home health care or up to 30 days after care begins. (42 CFR § 424.22.) (OEI; 01-12-00390; expected issue date: FY 2013; work in progress. Affordable Care Act.)

Employment of Home Health Aides With Criminal Convictions: OIG wants to see the rate of compliance with state requirements for criminal background checks for HHA applicants and employees. Federal law requires that HHAs comply with all applicable State and local laws and regulations. (Social Security Act, §1891(a)(5), implemented at 42 CFR § 484.12(a).) A previous OIG review found that 92 percent of nursing homes employed at least one individual with at least one criminal conviction. (OEI; 12-12-00630; expected issued date: FY 2013; work in progress)

States’ Survey and Certification: Timeliness, Outcomes, Followup, and Medicare Oversight: OIG will review the timeliness of HHA recertification and complaint surveys conducted by State Survey Agencies and Accreditation Organizations, the outcomes of those surveys, and the followup of complaints against HHAs. The office will also look at CMS oversight designed to monitor HHA surveys. (OEI; 06-11-00400; expected issue date: FY 2013; work in progress)

Missing or Incorrect Patient Outcome and Assessment Data: OASIS is a focus. OIG will look at OASIS data to identify payments for episodes for which OASIS data were not submitted or for which the billing codes on the claims are inconsistent with OASIS data. (OAS; W-00-13-35600; various reviews; expected issue date: FY 2013; new start)

Medicare Administrative Contractors’ Oversight of Claims: OIG will review the activities that CMS and its contractors performed to identify and prevent improper home health payments from January to October 2011. (OEI; 04-11-00220; expected issue date: FY 2013; work in progress)

Home Health Prospective Payment System Requirements: OIG will look at compliance and documentation with various aspects of the home health PPS, including the documentation required in support of the claims paid by Medicare. This includes looking at services including part-time or intermittent skilled nursing care, as well as other skilled care services, such as physical, occupational, and speech therapy; medical social work; and home health aide services. (OAS; W-00-12-35501; W-00-13-35501; various reviews; expected issue date: FY 2013 ;work in progress and new start)

Trends in Revenues and Expenses: OIG will review cost report data to analyze HHA revenue and expense trends under the home health PPS to determine whether the payment methodology should be adjusted. (OAS; W-00-10-35428; various reviews; expected issue date:FY 2013; work in progress)

I’ll have a post on more of the OIG report soon.

Read the entire OIG work plan