OASIS Alert

Published on Wed Feb 05, 2014 PDF

Get A Preview Of ICD-10 Codes For HH Grouper

Want to know how coming ICD-10 codes are going to affect your reimbursement? You may get an idea by looking at CMS’s ICD-10-CM Draft Manifestation and Etiology Code List.

“The list is being provided for review,” CMS says on its website. The list is in the “Downloads” section online at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/CMS-1450-F.html.

Medicare Increases Its Focus On Hospitalizations

You aren’t the only ones getting the third degree for hospital transfers. Skilled nursing facilities may soon have a new quality measure to report to CMS on nursing home resident hospitalization rates.

Why? The HHS Office of Inspector General thinks they’re transferring residents to hospitals too often, costing Medicare big bucks. So says a new OIG report examining Medicare nursing home resident hospitalization rates. Like in home care, hospital transfers are often necessary for nursing home residents to receive the acute-level care they need. But the OIG is blasting nursing homes for what the watchdog considers “high” hospitalization rates.

Beware: “Hospitalizations are costly to Medicare, and research indicates that transfers between settings increase the risk of residents’ experiencing harm and other negative care outcomes, “the OIG says. “High rates of hospitalizations by individual nursing homes could signal quality problems within those homes.”

The OIG’s study discovered that in fiscal year 2011, nursing homes transferred about one-quarter of their Medicare residents to hospitals for inpatient admissions, costing Medicare $14.3 billion in hospital expenses. Septicemia was the most common condition for causing nursing home residents’ hospitalizations, the OIG reports.

And although those hospitalization rates varied widely across nursing homes, the OIG did find commonality among the nursing homes with the highest annual rates of resident hospitalizations: nursing homes located in Arkansas, Louisiana, Mississippi, and Oklahoma, as well as facilities with one, two, or three stars in CMS’s Five-Star Quality Rating System.

Watch for: CMS agreed with the OIG’s recommendations, which were for CMS to “develop a quality measure that describes nursing home resident hospitalization rates” and to “instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.”

The report is at  http://go.usa.gov/Wyb3.

Manual Changes, Education Call Shed Light On Change In Improvement Standard

If you’re trying to get a handle on what the Jimmo settlement agreement means for your home health agency, you’ve got some more tools to help you figure it out.

Reminder: Last January, the U.S. District Court for the District of Vermont gave a final approval on a settlement with the Department of Health and Human Services in the class-action lawsuit Jimmo v. Sebelius. Under the settlement, HHS agreed to clarify that Medicare covers home health, therapy services and SNFs regardless of whether the beneficiary’s condition is expected to improve — known as the “improvement standard.”

The Centers for Medicare & Medicaid Services finally has issued Medicare manual up-dates incorporating the Jimmo clarifications. And CMS held an MLN Connects National Provider Call on the topic right before Christmas. An explanation of the manual updates is in a MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8458.pdf and the call transcript is at www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/JIMMO-12-19-13-Edited-Transcript.pdf.