Appeals:
Breathe A Little Easier On These Expedited Review Notice Topics
Published on Mon May 23, 2005
Hint: You can deliver the notice at the start of care if you want to. The expedited review notice may be a crushing new burden on you, but there are a few bright spots in new information on the requirement.
Good news: The Centers for Medicare & Medicaid Services appears to be treading lightly in the enforcement area for the requirement set to hit this week.
"CMS is well aware this review process is new to both beneficiaries and providers, and not much advance notice could be given to either because of the regulatory processes for finalizing both the regulation and notices," the agency says in its June 3 transmittal to intermediaries. "While all parties, including CMS, must make every attempt to meet these requirements, CMS realizes there will be many questions and possibly some missteps at the beginning."
Bottom line: "CMS will not seek to take punitive action in such cases as all involved parties become accustomed to the process," it says in the transmittal.
Don't dally: Of course, when that trial period ends is unclear, so smart providers will get their compliance ducks in a row as fast as they can.
HHAs shouldn't get "worked up" over the new requirement if they can't get all the details nailed down immediately, advises Burtonsville, MD-based attorney Elizabeth Hogue. As long as you thoroughly document a good faith effort to comply with the requirement, Hogue believes you'll be in the clear.
Here's a rundown of some other breaks providers received in the recent, voluminous guidance on the new notices: When to issue. Possibly the most transforming clarification is that agencies can issue the expedited review notices any time up to the second-to-last visit - including at the start of care. Nothing in the regulation precludes agencies from issuing the generic and detailed notices at the outset, CMS admitted in the June 20 special Open Door Forum on the topic.
Furnishing the generic notice up-front may be a practical strategy agencies want to adopt, suggests Gene Tischer with Associated Home Health Industries of Florida. "You can just make it part of your sign-up packet" if you can predict the discharge date accurately, Tischer notes.
Even if the discharge date changes, you can issue an amended notice when the change occurs instead of waiting until the last moment, Hogue points out.
Caveat: Regardless of when you issue the notice, beneficiaries can elect expedited review up to the day before discharge, CMS says.
Although this conduct would be in compliance, CMS indicated in the forum that it may frown on early notices. "The notice may be provided earlier than two days in advance, but should not be given so much in advance that the beneficiary fails to understand it is linked to discharge," CMS [...]
