Home Health & Hospice Week

Adjustments for OASIS item on prior inpatient stays befuddle HHAs.

If you're scratching your head over the amount of your M0175 takebacks in the first year of the prospective payment system, you're not alone.

Regional home health intermediaries Cahaba GBA and United Government Services posted the fiscal year 2001 adjustments for the OASIS item on patients' prior inpatient stays by the Oct. 24 deadline set by the Centers for Medicare & Medicaid Services (see Eli's HCW, Vol. XIV, No. 39). But RHHIs Palmetto GBA and Associated Hospital Service of Maine failed to do so.

Palmetto remedied the situation by posting its adjustments Nov. 4. AHSM planned to post its adjustments by Nov. 7, according to the National Association for Home Care & Hospice.

But the Palmetto list excludes 2,500 adjustments that "could not be re-created at this time," the intermediary says in a posting on its Web site. "Once we receive the adjustments from the Data Center, we will contact the impacted providers."

Because HHAs are supposed to have a five-week window to view the M0175 upcodes and downcodes, Palmetto will begin processing the adjustments Dec. 9. Cahaba and UGS will begin their processing on the original deadline of Nov. 28, they say. Adjustments Don't List Dollar Amounts But having the M0175 adjustments posted isn't helping many agencies figure out what they're going to owe for their incorrect answers to this OASIS item in FY 2001. "There is no way to determine any dollar amounts with these adjustments until the claims actually process at the Common Working File," Palmetto warns in its posting. "Providers can only determine the number of upcoded adjustments versus downcoded adjustments."

Some agencies have developed spread sheets to identify the status of individual claims, recounts consultant Judy Adams with LarsonAllen Health Care Group based in Charlotte, NC. "However, this process takes hours of work and requires the agency to go back and find the records and try to recalculate the amounts owed or due to them," Adams points out.

Consultant Pam Warmack with Clinic Connections in Ruston, LA says many HHAs are just ignoring the M0175 adjustments altogether, rather than spending time trying to figure them out. "It has proven a daunting task that no one wants to take on," Warmack tells Eli. Secure Ballpark Figure of Your M0175 Takebacks There is a relatively quick and painless way for HHAs to determine the dollar impact of their M0175 adjustments, offers consultant M. Aaron Little with BKD in Springfield, MO: 1. Look at the billing code. HIPPS codes will be up- and downcoded for M0175 answers in J-K or L-M pairs, Little explains. If the suspended claim was billed with a HIPPS code ending in J, it's being upcoded to a K. If it [...]