Archive for Home Health Care

The AMA obtains delayed enforcement of a regulation requiring proof of face-to-face encounters with patients referred for such services.

By Chris Silva, amednews staff. Posted Jan. 17, 2011. American Medical Association

Washington — Advocacy efforts by the American Medical Association helped persuade the Centers for Medicare & Medicaid Services to delay enforcement of a new regulation that requires physicians to document face-to-face encounters with patients for the beneficiaries to receive covered home health services.

The regulation, required under the health system reform law, went into effect Jan. 1. However, CMS decided to delay enforcement of the regulation for the first three months of 2011.

Patients always have needed physician authorization to receive home health services. The new documentation requirement is intended to ensure that a doctor’s order is based on up-to-date knowledge of the patient’s condition, CMS said.

Under the rules, a doctor or authorized nonphysician practitioner whose patient needs home health services must document a face-to-face visit with the patient within 90 days before the start of services and provide a separate certification that the patient is homebound and needs the care. For patients who start home health care based on a new condition without having seen a doctor in the past 90 days, the doctor must document a face-to-face visit and certification within 30 days of the onset of care for the services to be covered by Medicare.

The AMA had argued for a six-month delay of enforcement for the rule, saying that CMS had not done enough to make physicians aware of the new documentation requirements.

“We are deeply concerned that CMS has done little outreach to physicians affected by this requirement, and unless CMS postpones enforcement of this requirement, patients and physicians could be negatively impacted,” AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a Dec. 23, 2010, letter to CMS Administrator Donald M. Berwick, MD. The Association worried that home health agencies would start rejecting patients who did not have the appropriate documentation, forcing them into hospitals or nursing homes.

Dr. Maves said the AMA is pleased that the agency already made changes to the final rule based on physician recommendations, such as extending the window of time in which the face-to-face encounters can occur. But, he added, “We know from considerable experience that at least six months is needed to conduct outreach to physicians on new policies.”

Concerns about fraud, abuse

According to physicians familiar with the regulation, Congress authorized it and CMS developed it to improve access to home health services and prevent fraud and abuse.

“CMS was concerned about home care agencies serving patients who might not actually be eligible for coverage for the services,” said Edward Ratner, MD, associate professor of medicine at the University of Minnesota Medical School.

He said once physicians who see patients requiring home health care know about it, the documentation requirements shouldn’t prove too difficult for doctors.

“It requires some level of appropriate physician oversight, and it might be messy at first, but hopefully it won’t be too onerous,” Dr. Ratner said. “It’s important for physicians to make sure they don’t stop referring. We don’t want to underserve our patients because there’s a new paperwork requirement.”

C. Gresham Bayne, MD, an emergency physician in the San Diego area, said physicians who already make house calls should not have a problem with the new regulation. He said such doctors already have had to document the “medical reasonableness and necessity” of home visits for years. However, he said office-based physicians may have more trouble with the new documentation requirements.

These doctors “simply have fewer options to the quandary of seeing patients who cannot be seen in the office,” said Dr. Bayne, who is also the chair and founder of Call Doctor Medical Group, a San Diego-based organization that provides board-certified physicians and physician assistants to provide house calls to patients. He started the organization after seeing firsthand how costly unnecessary emergency department care can be.

Dr. Bayne added that patients of office-based physicians who may need home care services could encounter access problems if they’re not made aware of the new face-to-face visit requirements. The vast majority of homebound patients do not have any contact with doctors or nonphysician practitioners who make house calls, he said.

Still pushing for more time, outreach

Some physicians who refer patients for home health services said the 90-day delay in the regulation will be advantageous.

“Pushing back the deadline is helpful, because I don’t think a lot of doctors knew about this regulation,” said Peter Boling, MD, professor of medicine and interim chair of the division of internal medicine at Virginia Commonwealth University School of Medicine in Richmond. “Home health agencies worry that patients will not have a timely certifying visit post-hospital that will support agency billing.”

Dr. Boling said typical problems with documentation and continuity under the new rules could arise when a patient initially is treated for an illness in a hospital and is then placed on home care after discharge without a solid hand-off.

That’s one of the reasons the AMA continues pushing for a full six-month delay of enforcement from CMS. In the meantime, the Association is calling on CMS to continue educating physicians about the new requirements, as well as the contractors who will need to process the related claims.

In accordance with the Patient Protection Affordable Care Act, CMS issued a Final Regulation that goes into effect January 1, 2011 whereby Medicare will pay for home health services only when a patient has had a face-to-face encounter with the physician …that certifies the home health plan of care. The patient for whom you’ve ordered home health services must have a documented face-to-face encounter with you within 90 days prior to, or take place by 30 days of, the start of home health services. The primary reason for which your patient needs home health services must be addressed during the encounter.

For more information Contact Options Home Health.


Date on ALL Medicare Home Health Orders

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Article By hcafadmin

Sadly it is official, in the state of Florida a physician must place a date on all Medicare home health orders that he/she signs. This includes the 485 (initial certifications and recertifications) along with all interim orders!

No longer can the agency apply a date or stamp the date on the order if the physician inadvertently leaves off the date. On or after January 1, 2011 all orders and subsequent services/claims based upon those orders would have to have the physician signature dated by the physician or those claims could be denied.

Change your processes immediately so that physicians and referral sources can start to realize that a order not dated will simply have to be sent back to them! It would also be beneficial to make sure that the physician and his/her office staff clearly understand that the date has to be provided by the physician, not written in by the physician’s staff or stamped on the document by the physician’s staff.

Home care providers will need to protect themselves from unsubstantiated claim denials or from having to prove to a surveyor that the stamped date on the document , or the different colored ink was placed there by the physician not the homecare agency.

Finally, make sure the aggravated physician understands that this frustrating, ridiculous requirement is being forced upon them and upon the home care industry by CMS!

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Senior’s Need to Stay Warm

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Hypothermia and Seniors Staying Warm during Cold Winter Months

By: Wendy D’Uva – Options Home Health

In most parts of the country, a 60-degree day would hardly count as a cold snap. And yet if a senior citizen lives in a poorly insulated house and keeps the heater off to save money, such a day might be chilly enough to cause a hazardous drop in body temperature. As people get older, their bodies become a little less efficient at regulating heat. And if the body temperature dips below 94 degrees, hypothermia sets in: The person becomes confused, speech is slow and slurred, the pulse weakens, movements become clumsy, and the body often shivers uncontrollably (although some people don’t shiver at all). Mainly, this happens because their heart rates have slowed, blood vessels no longer contract as well, and muscle tone and body fat have been lost. The risk of developing hypothermia also increases among senior citizens that have under active thyroids, suffer from diabetes or heart disease, or take certain prescribed medications. Medications that can increase an older person’s risk for hypothermia include drugs that are used to treat anxiety, depression or nausea, and even some over-the-counter cold remedies. And all this can happen on a day when most people don’t even bother to wear a coat.

Hypothermia symptoms usually begin slowly. As you develop hypothermia, your ability to think and move often becomes clouded. In fact, you may even be unaware that you need help. As your thought process is impaired, you fail to realize that you are becoming colder.

As the colder months approach we all need to be aware of the warning signs of hypothermia, and of ways to prevent hypothermia from occurring. Changes in a person’s behavior may indicate that the cold is affecting how well their muscles and nerves work. It is best to watch for the “umbles”-stumbles, mumbles, fumbles, and grumbles.

Symptoms may include:

  • Confusion, forgetfulness, or drowsiness
  • Difficulty speaking
  • Shivering- although elderly adults may not have this symptom
  • Slow breathing
  • Clumsiness or stiff muscles

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Home Health Care Benefits

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Recovering from an illness or injury can be a stressful time for both the patient and the patient’s family. That stress is compounded when chronic illness or disability is involved. Research has consistently shown that, when at all possible, recovering at home is the best option for the patient’s physical and mental health. Unfortunately, when the patient is elderly or too injured or ill to care for themselves, recovering at home is sometimes not an option.

Finding friends or family members to assist with daily tasks is not always feasible. Even when family members are in a position to assist, the burden placed on them often puts a strain on their other family relationships, as well as their career and personal life. The alternative to home recovery-having their loved one leave their home to life in a medical facility or nursing home-is often a last and regretful resort.

Luckily, there is another way for patients to remain in their beloved homes while receiving quality health care assistance: Home Health Care. Recent technological advance such as the internet and home infusion have made home health care available to many more patients than in the past. According to the National Association for Home Care, there are approximately 20,000 home health care providers today. While almost two-thirds of home care recipients are seniors over 65, home health care can assist anyone who requires some assistance while recovering from an illnesses or suffering a disability.

Here are some benefits of home health care:

Seniors can continue living in their own familiar, comfortable environment
Dignity and independence is maintained
Patients receive one on one attention and care from the home health caregiver
Home health care is often less expensive than care in nursing homes / assisted living facilities
It relieves the burden placed on adult children to provide care for their aging parents

Most people prefer receiving care in a familiar setting where they are surrounded by love, patience and understanding people. Home health care providers help strengthen and increase the patient’s ability to care for themselves in their homes. They can also have a positive impact on a patient’s hopes and aspirations.

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