OASIS Alert

Published on Tue Aug 19, 2008 PDF

Diagnosis coding guidance also discussed in CMS forum.

You're going to have to wait a bit longer to get your M0110 underpayment.

The Centers for Medicare & Medicaid Services announced back in March that the claims system wasn't counting 2007 episodes when calculating "early" or "later" status for episodes under the prospective payment system refinements that took effect Jan. 1. That error underpaid many agencies when episodes that were really "later" were downcoded to "early."

But CMS didn't implement the software fix for the problem until July. And it still hasn't announced a date for making claims adjustments for the M0110 sequencing problem and other PPS refinement errors.

"Due to the number and complexity of those issues, CMS is still developing the schedule for all of the adjustments," CMS' Wil Gehne said in the Aug. 13 Open Door Forum for home care. "A one-time notification instruction will be issued very soon that outlines the final schedule."

CMS is "still developing instructions for intermediary initiated adjustments that will take place to resolve payment issues with home health claims since the January 2008 implementation of the HH PPS refinement," regional home health intermediary Cahaba GBA adds in a message to providers.

Other CMS news: Help is on the way for your diagnosis coding dilemmas, CMS' Lori Anderson said in the forum. The agency is working on updating its guidelines for home care diagnosis coding, she said. "We hope to have it out there soon."

• MedQIC's home health quality tools has moved to a brand new Web site. You can now find information from www.medqic.com by going to www.qualitynet.org/MedQIC, notes Quality Improvement Organization Qualis Health in a posting on its Web site.

• Home care providers often complain that the outcomes-based quality improvement standard on emergent care is largely out of their control, and some new findings may back up that argument.

The number of emergency department visits in the U.S. increased by 36 percent to 119 million in 2006, as compared to 90 million in 1996, according to a recent Centers for Disease Control report on hospital use. Of every 100 Medicaid beneficiaries, 82 used ED care in 2006, compared to 21 of every 100 people with private insurance, the report says.

People older than 75 were the second-highest users of ED care, the report found. The report is online at www.cdc.gov/nchs.

• Hang onto your laptops. The HHS Office for Civil Rights has made its first big settlement over Health Insurance Portability and Accountability Act violations.

Seattle-based health system Providence Health & Services will pay $100,000 and enter into a three-year Corrective Action Plan over highly publicized privacy breaches at Prov-idence Home and Community Services and Providence Hospice and Home Care, OCR reports in a release.

The resolution agreement and plan between Providence and the OCR is at www.hhs.gov/ocr/privacy/enforcement.

• Fall prevention programs cut falls among the elderly by 11 percent in a new study by Yale School of Medicine researchers published in the July 17 New England Journal of Medicine.

The researchers "used a combination of fall prevention educational campaigns and interventions aimed at encouraging clinicians to incorporate fall-risk assessment and management into their practices," according to a release from the school.

The study is the first to examine the effects of fall prevention strategies when used by elderly patients' own health providers -- including home care nurses -- instead of researchers.

Gentiva Health Services Inc. is touting its own fall prevention program. In a survey of more than 10,000 patients who were treated in 2007 by the Gentiva Safe Strides home balance therapy program, 96 percent showed a reduction in their risk of falls between admission and discharge, the Melville, NY-based company says in a release.

Among the people surveyed, 95 percent were age 65 or older and 69 percent were women.