Posts tagged ‘medicare’

November 28, 2012

It’s The End of the World as We Know It (Or Why M1024 Will Change Home Health)

There’s a lot of hype about the world ending in 2012. I don’t believe that, but it reminds me of an REM song & M1024—“It’s The End of the World as We Know It.”

Why? M1024 and its predecessors, M0245 and M0246 have been a part of our home health coding world since 2003 when we started using V codes in our coding. Medicare’s final rule for PPS 2013 limits the use of M1024 to only one particular instance for payment diagnoses beginning Jan. 1, and the plan is to decimate it all together once ICD-10-CM is ushered in Oct. 1, 2014. I applaud deleting M1024 from the OASIS, but I desire a different outcome with the remnants of M1024.

M1024 will be used for fractures only beginning in January. Medicare, in a surprise move, stated that resolved conditions do not belong in M1024 and we shouldn’t have been earning points there. CMS reports that the change will be minimal to our case mix scoring, however other sources report that as many as 60% of our assessments include resolved case mix diagnoses in M1024—that will mean a drop in our payment.

We can still get primary points for diabetes, Neuro 1 and Skin 1 case mix diagnoses if we sequence correctly without using M1024 according to Medicare’s grouper change. But, there is one frequently used method for coding that can mean the end of those points if coders are not careful (less points = less money for those who need it spelled out).

I have a short recording on the change to M1024 that will be posted on my website soon and do not miss the opportunity for more in-depth instruction on the change and its impact in upcoming classes in Dallas and Corpus Christi in December. Check my website for details.

So, it’s the end of the world as we know it. It remains to be seen if we’ll “feel fine.”

October 29, 2012

Settlement could affect Medicare coverage with HHAs

We don’t know when changes might happen, but this could help HHAs.

Settlement Eases Rules for Some Medicare Patients

… In a proposed settlement of a nationwide class-action lawsuit, the Obama administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve….

November 10, 2011

Medicare expands coverage of cardiovascular disease prevention services

The Centers for Medicare & Medicaid Services (CMS) will add coverage for a number of preventive services to reduce cardiovascular disease. 

CMS will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. The visit must be furnished by primary care practitioners, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices. During these visits, providers may screen for hypertension and promote healthy diet as part of an overall initiative to reduce the burden of cardiovascular disease in the United States.

The new coverage policy does not change current Medicare coverage for beneficiaries diagnosed with cardiovascular disease to receive assessment and intervention services.     

Earlier this year, the U.S. Department of Health and Human Services announced its Million Hearts national initiative, aimed at preventing a million heart attacks and strokes in the U.S. by 2017. Through Million Hearts, CMS, the CDC, and other HHS agencies are working together with public and private sector organizations to make a long-lasting impact against cardiovascular disease.

Find out more about Million Hearts.

Read the new coverage policy.

October 23, 2011

Hospitals struggle to reduce readmission rates

We talk so much about lowering readmission rates in hospitals and how that can impact other areas of homecare. Read this for some recent stats that show readmissions didn’t really change between 2003 and 2009.

The Dartmouth Institute for Health Policy and Clinical Practice report shows that hospitals struggled to lower readmission rates among Medicare patients between 2003 and 2009. The report comes as hospitals prepare for Medicare penalties for high readmission rates that start in October 2012.

Read the report here …

March 31, 2011

CMS says face-to-face does start April 1 (tomorrow!)

The Centers for Medicare & Medicaid Services (CMS) has just issued the following statement on the enforcement of the face to face requirement:

Effective April 1, 2011, the Centers for Medicare & Medicaid Services (CMS) expects home health agencies and hospices have fully established internal processes to comply with the face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for purposes of certification of a patient’s eligibility for Medicare home health services and of recertification for Medicare hospice services.

Section 6407 of the ACA established a face-to-face encounter requirement for certification of eligibility for Medicare home health services, by requiring the certifying physician to document that he or she, or a non-physician practitioner  working with the physician, has seen the patient.  The encounter must occur within the 90 days prior to the start of care, or within the 30 days after the start of care.  Documentation of such an encounter must be present on certifications for patients with starts of care on or after January 1, 2011.

Similarly, section 3131(b) of the ACA requires a hospice physician or nurse practitioner to have a face-to-face encounter with a hospice patient prior to the patient’s 180th-day recertification, and each subsequent recertification.  The encounter must occur no more than 30 calendar days prior to the start of the hospice patient’s third benefit period.  The provision applies to recertification’s on and after January 1, 2011.

On December 23, 2010, due to concerns that some providers needed additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for purposes of certification of a patient’s eligibility for Medicare home health services and of recertification for Medicare hospice services, CMS announced that it will expect full compliance with the requirements, beginning with the second quarter of CY2011.

Throughout the first quarter of 2011, CMS has continued outreach efforts to educate providers, physicians, and other stakeholders affected by these new requirements.  CMS has posted guidance materials including a MLN Matters article, questions and answers documents,  training slides, and  manual instructions which are available via  CMS’ Home Health  Agency Center and Hospice webpages.  CMS’ Office of External Affairs and Regional Offices contacted state and local associations for physicians and home health agencies and advocacy groups to ensure awareness about the face-to-face encounter laws, and to distribute the educational materials.

CMS will continue to address industry questions concerning the new requirements, and will update information on our Web site at http://www.cms.gov/center/hha.aspand http://www.cms.gov/center/hospice.asp.

 

Look at some of my previous blog posts on face-to-face encounters:

NAHC receives many responses to face-to-face

Medicare updates face-to-face questions