Posts tagged ‘home health’

November 13, 2012

Readmissions rise without HH support

From FierceHealthcare:

New research adds even more fuel to the fire, in which some providers argue they face unfair financial penalties for readmissions outside of their control, with social factors affecting patients returning to the hospital.

According to a new study in the October-December Advances in Nursing Science journal, elderly patients who lacked support in a home health setting after a hospital stay fared worse than those who had a solid support system for self-care.

Hong Tao, assistant professor at University of Wisconsin Milwaukee College of Nursing, and other researchers found that a “self-care deficit” in the elderly post-hospitalization population correlated to bouncing back to the hospital, according to yesterday’s research announcement. Patients’ living arrangements, such as whether they lived alone or had a family member as a primary informal caregiver, as well as the frequency of care and the type of care provided, were all related to readmissions.
Researchers also found that the patients’ age, obesity, lower levels of cognitive functioning also were linked to the self-care deficit.

“Patients who received more care were more likely to have a better functional ability,” study authors wrote.
Out of the more than 1,200 elderly home healthcare patients studied, about 21 percent were rehospitalized within 60 days of being released from the hospital to home care; most of those people were back in the hospital in less than 20 days.

With 1 in every 4 patients discharged from hospital to home health being rehospitalized, national readmissions stood at a steady 29 percent in 2008, compared to 28 percent in 2004, according to the study.

Researchers noted the takeaway for providers is to improve social environmental support for the patients but also improve help for the informal caregivers.

“Caregivers of these patients may benefit from additional resources to help them manage the tiring physical demands of their patients,” they wrote. “… Those patients who received environmental support from their caregivers in the form of psychosocial support, facilitating access to medical care or serving as a financial and/or health agent, tended to benefit, function at a higher level and have less potential for rehospitalization.”

February 6, 2012

AHRQ database of clinical practice guidelines are at your fingertips

This webpage has a top-level directory of all of the practice guidelines. Ones that interest home health the most:

Pressure ulcer prevention

Pain management, including cancer and acute pain

Urinary incontinence

Heart failure and cardiac rehabilitation

Take a look at your agency’s policies and see if things can be improved!

January 26, 2012

Watch for Palmetto and other probe edits … We can help!

Probe edits are underway from Palmetto with other MACs joining in soon. It is important to follow instructions from your MAC and respond with complete copies of charts.

Selman-Holman & Associates, LLC has been assisting clients with this process for many years and we have been heavily involved in responding to the new round of ADRs and probe edits. Your agency is at greater risk if you 1) have a long length of stay (LOS); 2)  have Medicare beneficiaries under the age of 65; and 3) have frequencies of 1w9.

Call us for assistance if you receive a probe notification letter or ADRs. We have an expert team of home health care documentation and coverage experts standing by!

Message from Palmetto:

From: Jurisdiction 11 Home Health and Hospice

Alert: Medical Additional Documentation Requests (ADRs)

Palmetto GBA recently changed the process for mailing medical Additional Documentation Requests (ADRs).  Previously, medical ADRs were mailed in yellow envelopes. ADRs are now mailed in white Palmetto GBA envelopes. It is possible that a provider may receive an ADR request prior to receiving their probe notification letter.

If you receive an ADR, it is important that you respond promptly.

September 19, 2011

Read up on PT assessment exceptions

CMS has answered issues with single therapy visits …

Question: Can you please clarify this for me? If we are only doing physical therapy (PT) and the 30-day re-evaluation not only falls on the 12 visit and on a Friday and then come Monday is the 13 visit, do I have to send out the PT for another re-evaluation? We are concerned that a 30-day reassessment conducted on the 12th PT visit in single therapy cases will not suffice to meet the 13th therapy visit assessment. If it doesn’t meet requirements, there would be a large financial impact based on non-coverage of subsequent PT visits.

CMS Response: You are correct that for a single therapy case, the therapist must do the reassessment visit exactly on the 13th and 19th visits, unless the rural or documented circumstances outside the control of the therapist exceptions apply as stated in 42 CFR 409.44(C)(2)(i)(C). If neither exception applies, the PT would need to do the reassessment on the 13th visit as required by the regulations.

August 11, 2011

New guidelines are here!

Coding Guidelines were released today, effective Oct. 1, and it does not appear there is anything earth-shattering. With the new glaucoma codes have come a slew of new glaucoma guidelines. Here are some highlights:

Glaucoma additions break out guidelines for glaucoma 365,1-365.7, then breaks the guidelines out by: bilateral glaucoma with same stage, bilateral glaucoma stage with different stages, bilateral glaucoma with different types and different stages, patient admitted with glaucoma and stage evolves during the admission, and undetermined glaucoma stage. (Chapter 6.b)

There is a slight change in the wording of Late effects:
“A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first.    The late effect code is sequenced second.

Exceptions to the above guidelines are those instances where the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s) or the classification instructs otherwise. The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect.” (Section 1.B.12)

Septic shock (Chapter 1.b.6.a, Chapter 1.b.6.b) include additions for sceptic shock codes:
785.52, Septic shock or 998.02, Postoperative septic shock.

Postprocedural infection and postprocedural septic shock changes address postprocedural infection and complications. Codes involved include: 998.59, 674.3x, 995.92, 998.02. (Chapter 1.10)

Anemia associated with malignancy. There is a clause addition to this area of the guidelines. “If anemia in neoplastic disease and anemia due to antineoplastic chemotherapy are both documented, assign codes for both conditions.” (Chapter 2.c.1)

Complications of care (Chapter 17.f.1) specifies that An additional code identifying the complication should be assigned with codes in categories 996-999, Complications of Surgical and Medical Care NEC, when the additional code provides greater specificity as to the nature of the condition.