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Home Health & Hospice Week

Industry Notes:

HHA SATISFACTION SURVEY STARTS ROLLING OUT

Published on Tue Mar 17, 2009

Participation in patient satisfaction survey is voluntary -- for now.

If you'd like to take an advance look at the feds' home health patient satisfaction survey -- or even start using it -- now's your chance.

The Centers for Medicare & Medicaid Services has requested Office of Management and Budget approval for the new Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey. The survey "is designed to measure the experiences of people receiving home health care from Medicare-certified home health care agencies," CAHPS contractor RTI notes on the CAHPS Web site.

Public outcomes: CAHPS participation is voluntary for now, CMS notes in an April 10 Federal Register notice. But the agency "plans to implement a process to measure and publicly report home health care patient experiences through" the survey, CMS notes. "Home Health Care CAHPS Survey results will be publicly reported on Home Health Compare once an agency has four quarters of data," RTI notes on the CAHPS site.

Whether or not you decide to use the survey,you can submit your comments on the new tool to CMS by May 11.

Thirty-four HHAs field-tested the CAHPS survey last year. The National Quality Forum is currently in the approval process for the final form.

HHAs that want to participate in the survey must use an approved vendor. CMS is soliciting vendors and volunteer agencies now.

"The survey captures topics such as patients' interactions with the agency, access to care, interactions with home health staff, provider care and communication, and patient characteristics," CMS notes in the Federal Register. "The survey allows the patient to give an overall rating of the agency, and asks if the patient would recommend the agency to family and friends."

Resource: Information about the survey, how to participate, and a copy of the survey itself are at  www.homehealthcahps.org.

• On the eve of the durable medical equipment competitive bidding rule's revised implementation date, April 18, suppliers urged policymakers to rescind the damaging program.

"The rule, which would re-implement Round One of the bidding program in the DME sector of Medicare, would reduce access to care and put thousands of DME providers out of business, eliminating jobs at a time when the federal government is trying to preserve them," the American Association for Homecare and 27 state and regional DME trade groups said in an April 13 letter to the acting Department of Health and Human Services Secretary,the acting CMS Administrator, and newly appointed director of the White House Office of Health Reform Nancy-Ann DeParle. "The rule does not address the fundamental problems of the program that came to light during its brief implementation last year," the industry representatives charged in the letter.

"The intent behind the [legislative] provisions on bidding was for CMS to correct the fundamental flaws of Round One of bidding, allowing for feedback from stakeholders through a comment period before CMS issued a final rule," the trade groups say in the letter. "This process did not take place and the flaws in the bidding program remain."

Any savings from the program will be outweighed by increased hospital costs due to service cutbacks in line with reimbursement reductions, the reps argue. And it will put up to 90 percent of suppliers in bidding areas out of business. "Many of these practices are small businesses already struggling under the current economic recession," the trade groups say.

The industry isn't just relying on policymakers to do the right thing, however. The National Association for Independent Medical Equipment Suppliers and DME member service organization VGM have written letters to influential members of Congress asking them to delay bidding once again.

"Because of the agency's rush to implement this rule, the program will once again eliminate hundreds of Medicare DME providers across the country,"VGM says in its letter.

• If you want to avoid hospice audits from CMS, you'd be wise to shore up your policies and procedures in risk areas that are catching the feds'attention. Medical reviewers are targeting continuous home care (CHC), invalid hospice elections due mainly to lack of supporting documentation, tooearly admissions, long lengths of stay (exceeding 110 days), and irregular billing such as billing more than once a month, said CMS's Latesha Walker at the National Association for Home Care & Hospice's March on Washington conference March 23. (See related story, p. 116, for tips on combating hospice eligibility problems in your documentation.)

CMS recently moved its medical review division from the program integrity department to the compliance group, Walker explained.

• The transition to ICD-10-CM might be a little less painful, thanks to new tools from CMS that help you crosswalk from the current diagnosis code set (ICD-9-CM) to the new one.

CMS's general equivalence mappings offer a backward and forward crosswalk tool to help you convert diagnosis codes between the two systems.

Keep in mind: In some cases, you won't find a direct one-to-one match between the code sets. Instead, one ICD-9 code may lead you to several options on the ICD-10 code set.

You can review the general equivalency mappings at www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp. CMS will hold a May 19 conference call that will provide an ICD-10 overview, an explanation of the mappings, and ICD-10 transition planning advice. More information about the call is online at www.cms.hhs.gov/ICD10/07a_2009_CMS_Sponsored_Calls.asp.

• Good news for hospices that submit claims with physician services:Aclaims system fix for a doc service-related error will be here sooner than originally thought.

The problem: An error with the Outpatient Code Editor is causing hospice claims that contain physician services to return to provider (RTP) with reason code W7072.

The solution: The system fix was originally scheduled for October, but now has been moved up to July, notes regional home health intermediary Cahaba GBA on its Web site.

Until then, use the following workaround to get such claims paid: First remove the physician services from the claim and F9 your claim, Cahaba instructs. Then "once the claim has processed (PB9997), you may submit an add-on claim (TOB 8X5) for the physician charges which were removed from the claim," the intermediary says.

• Starting in July, you'll be eligible to receive a bit more payment for oxygen equipment that has exceeded the 36-month rental cap. For equipment under HCPCS codes E1390, E1391,E1392, and K0738, suppliers can bill for a maintenance and service visit using the codes with modifiers --E1390MS, E1391MS, E1392MS, or K0738MS, respectively, CMS explains in March 20 MLN Matters Article No. 6404.

Medicare won't pay for maintenance and service for both a portable oxygen concentrator (E1392MS) and portable oxygen transfilling equipment (K0738MS), CMS says.

Suppliers may only receive such payments once every six months, starting six months after the cap ends. That means the first maintenance and service visits will be eligible in July for equipment that exceeded the cap in January.

Suppliers may bill for the service only if they make an in-home visit to inspect and service the equipment, CMS instructs.

Codes excluded from maintenance and service payments are E0424, E0439, E0431, E0434,E1405, or E1406, CMS says.

Amount: "The allowed payment amount for each visit is equal to the lesser of the supplier's actual charge or the 2009 fee for code K0739, multiplied by 2, for the state in which the in-home visit takes place," CMS explains.

More information is at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6404.pdf.

• Getting your direct care staff to use proper hand hygiene should be at the top of your infection-control priority list, says accrediting body The Joint Commission (formerly known as JCAHO). But figuring out exactly what protocol to require and then encouraging and measuring compliance can be tricky.

Now a tool from the Oakbrook Terrace, Ill.-based accreditor, developed in conjunction with a group of federal and private groups, may help. The monograph includes reviews of the strengths andweaknesses of commonly used approaches, examples of measurement methods and tools, and references to evidence-based guidelines and published literature, the Commission says.

The tool is available online at www.jointcommission.org/PatientSafety/InfectionControl/hh_monograph.htm or email customerservice@jointcommission.org for a free copy.

• The economic crisis may lead to you seeing patients with worse diabetes complications.

People with diabetes are cutting back on doctor visits, treatment, and testing during the economic recession, says the New York Daily News.Physicians have seen a decrease in appointments by people with diabetes, sales of popular diabetes medications and supplies have decreased, and many people with diabetes are choosing cheaper insulin injections rather than more costly drug therapy, the newspaper reports.

• States continue to trim their budgets in this tough economy, and home care persists as a popular target for cuts.

For example, Arizona has ended a home health assistant program that provided the elderly and those with disabilities assistance with daily care activities and travel to physician appointments,reports the New York Times.

"There's no question that we're getting short-term savings that will result in greater longterm human and financial costs," Linda Blessing,interim chief of the Arizona Department of Economic Security, told the Times. "There are no good options, just less bad options."

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