OASIS Alert

Published on Fri Oct 01, 2004 PDF

Follow these 8 steps to ensure you receive the payment you deserve.

You could plug a substantial money leak by running the numbers for every significant change in condition.

Problem: "Most agencies do not understand that they must calculate the impact of the SCIC on the episode payment for every SCIC," cautions Chapel Hill, NC-based consultant Judy Adams with LarsonAllen Health Care Group. A SCIC early in the episode or one that adds therapy - changing the response to M0825 to "yes" - often results in a financial benefit to the agency, Adams says. But without calculating both portions of the episode (pre-SCIC and post-SCIC), you cannot determine if filing will gain or lose money for the agency, she adds.

Solution: Even if your computer system doesn't do the math for you, calculating whether to file a SCIC when the HIPPS code increases "is relatively easy," says Pam Warmack, president of Clinic Connections in Ruston, LA. Follow these steps to ensure your agency files optional SCICs only when they will benefit your bottom line:

1. Divide the episode payment for the pre-SCIC case-mix weight by 60 to get the pre-SCIC per-day payment amount.

2. Count the number of days from the start-of-care visit to the last visit before the SCIC.

3. Multiply that number of days by the per-day amount.

4. Divide the episode payment amount that the post-SCIC increased HIPPS code would provide by 60 to get the post-SCIC per-day payment amount.

5. Count the number of days from the first visit after the SCIC occurred (such as a resumption of care visit) through the end of the episode.

6. Multiply that number of days by the post-SCIC per day amount.

7. Add the number from step 3 and the number from step 6.

8. Compare that sum with the total episode payment you would receive if you didn't file a SCIC. If the pre-SCIC episode payment is larger than the number in step 7, do not file the SCIC.