Medicare Compliance & Reimbursement

Every discharged patient must be issued notice.

A massive new paperwork mandate requiring HHAs to issue a notice to every single patient they discharge is ready to land this summer, and it's as confusing as ever.

The Centers for Medicare and Medicaid Services has submitted its new termination and expedited review forms to the Office of Management and Budget for approval, according to a CMS notice in the April 29 Federal Register. The notices are virtually unchanged from the forms CMS issued in conjunction with its final rule on the matter last November.

Warning: The new termination notices will cause mass confusion, industry experts say.

"This will be a busy season for process changes," notes William Dombi, vice president for law with the National Association for Home Care & Hospice's Center for Health Care Law. Problems With New Notices Abound HHAs are chagrined that CMS seems to have taken almost no notice of the grave concerns they raised in response to the final rule, which did allow comment submission. For example, health care attorney Elizabeth Hogue submitted a list of serious problems with the new notices, "but apparently it's just been ignored," she fumes.

Here are top problems with the notices:
 
Physician orders: During the new 72-hour expedited  review that the notice can trigger, CMS instructs HHAs and hospices to continue services for the three-day period. But home care providers can't furnish services without a physician's order under the Medicare Conditions of Participation, protests consultant Lynn Yetman with Reingruber & Co. in St. Petersburg, FL.

Appropriate usage: The instructions for using the new termination notices are highly confusing, experts agree. CMS has not clarified whether patients will sometimes receive termination notices, ABNs or both at the end of their care - and why.

Timeline: Requiring HHAs to furnish the new termination notices at least two days prior to discharge will likely mean an extra visit for many beneficiaries, expects Hogue, based in Burtonsville, MD. 
 
That's a huge burden, especially for rural providers who travel long distances to reach patients