PowerPoint Presentation

1 4/30/2015 1 Home Health Documentation and Utilization of the Home Health Benefit for Medicare Patients Michigan Association for Home Care 2015 1686_0215 Home Health Shelly Bernardini RN, CPHM HH Clinical Consultant Jurisdiction K & Jurisdiction 6 2 Today s Presenters Home Health National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material.

2 Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the CMS website at 3 Disclaimer 4/30/2015 2 Home Health Attendees/providers are never permitted to record (tape record or any other method) our educational events This applies to our webinars, teleconferences, live events and any other type of National Government Services educational events 4 No Recording Home Health Acronyms used in this Presentation can be viewed on the website.

3 On the Welcome page, click on Provider Resources > Acronyms. 5 Acronyms Home Health 6 Agenda Part One Part Two Eligibility Additional Documentation Requests (ADR s) Receiving Mock Charts Collection of the Medical Record Review of Materials Prior to Submission Collaboration of Documentation Face to Face Encounters (F2F) Plan of Care (POC) Homebound Status Need for Skilled Services Certification Documentation Processes Documentation Collaboration Best Practice Examples References & Resources 4/30/2015 3 Home Health Medicare Home Health Eligibility 7 To be eligible for Medicare home health services, a patient must have Medicare Part A and/or Part B and, per 1814(a)(2)(C) and 1835(a)(2)(A) of the Act: confined to the home; skilled services; under the care of a physician; services under a plan of care established and reviewed by a physician.

4 And had a face-to-face encounter with a physician or allowed non-physician practitioner (NPP). Home Health Request for documentation to support the claim previously submitted Upon receipt, it is imperative to have a process or policy in place to ensure that the documentation is collected efficiently and appropriately Mock Charts Staff Member(s) Assigned to Collect Documentation in Order of the Mock Chart Staff Members Assigned to Review Documentation Prior to Submission 8 Additional Development Request Home Health 9 Additional Development Request THIS CLAIM REQUIRES ADDITIONAL INFORMATION IN ORDER TO MAKE APPROPRIATE PAYMENT DETERMINATION AND PROCESSING.

5 PROVIDED BELOW ARE RECOMMENDED SUPPORTING DOCUMENTS, BUT NOT AN ALL INCLUSIVE LIST. THE DOCUMENTATION SHOULD SUPPORT THE VERIFICATION OF THE ISSUE THAT GENERATED THIS REQUEST. FOR FURTHER INFORMATION, ENTER THE REASON CODE(S) LISTED BELOW IN THE APPROPRIATE FIELDS IN THE ON-LINE SYSTEM. WE ACCEPT DOCUMENTS VIA PAPER, FAX, CD/DVD AND ESMD OMB #0938-0969 PLEASE NOTE: **MEDICAL** RECORDS ARE DUE TO THE MAC WITHIN 45 CALENDAR DAYS. *NON-MEDICAL* RECORDS ARE DUE TO THE MAC WITHIN 14 CALENDAR DAYS.

6 45 Days 4/30/2015 4 Home Health 10 Additional Development Request MEDICARE REQUIRES A LEGIBLE IDENTIFIER FOR SERVICES PROVIDED AND ORDERED. MEDICARE WILL ACCEPT CLEARLY LEGIBLE HANDWRITTEN SIGNATURES, HANDWRITTEN INITIALS OR ELECTRONIC SIGNATURES. STAMPED SIGNATURES ARE NOT ACCEPTABLE ON ANY MEDICAL RECORD. Home Health 11 Additional Development Request Home Health 12 Additional Development Request CONSIDER THE FOLLOWING LIST AS A DOCUMENTATION GUIDE WHILE PREPARING RECORDS IN RESPONSE TO THIS REQUEST: PLEASE INCLUDE THE FOLLOWING ITEMS: - ALL APPLICABLE PHYSICIAN SIGNED PLANS OF CARE (485) FOR THE CLAIM PERIOD; - ALL SIGNED PHYSICIAN ORDERS PERTAINING TO THE PLAN(S) OF CARE; - CLARIFY HOMEBOUND STATUS, INCLUDING FUNCTIONAL AND ACTIVITY LIMITATIONS.

7 - ALL DISCIPLINE NOTES AND FLOWSHEETS, INCLUDING INITIAL EVALUATIONS AND SUMMARY REPORTS. - FOR ANY DME BILLED, PLEASE INCLUDE THE MEDICAL EXPLANATION OF NECESSITY, AND ANY SUPPORTING DOCUMENTATION. -IMPORTANT, PLEASE INCLUDE ALL OASIS FORMS, INCLUDING ANY SCIC OASIS FOR THE CLAIM PERIOD LISTED. -IF THERE IS AN ABN ON FILE, PLEASE SUBMIT THE ABN WITH THE REQUESTED DOCUMENTATION. -PLEASE INCLUDE DOCUMENTATION TO SUPPORT THE FACE TO FACE encounter 4/30/2015 5 Home Health Other sources of documentation that often assist in defining the patients need for skilled services and homebound status may include.

8 Discharge Summary Inpatient History & Physical Inpatient Plan of Care Case Management and Discharge Planner Documentation from Inpatient Facility 13 Additional Development Request Home Health Prior to submission of documentation, it is imperative that all paperwork is completely reviewed to ensure: All pages are for the appropriate patient The patients name is on each page The correct dates of service for all materials Dates and signatures are clear and appropriate Legibility Accuracy Documentation supports the patients need for skilled services Homebound status is identified and comprehensible (as per CMS guidelines)

9 14 Additional Development Request Home Health Collaboration of Documentation It is the responsibility of the referring, certifying &/or community physicians to record all pertinent HH information in the medical record and collaborate all documentation with the HHA HHA documentation is also reciprocal; as it compliments & supports documentation in the referring, certifying &/or community physicians records. 15 4/30/2015 6 Home Health Q&A Discussion Period 16 Home Health Face to Face encounter , Plan of Care and Certification Documentation Collaboration 17 Home Health 18 Home Health Agency Referring Physician Therapist DME Pharmacy Community Physician Collaboration of Documentation 4/30/2015 7 Home Health 19 Collaboration of Documentation Referring Physician Referral Orders F2F/POC Certification DME, Therapy.

10 Pharmacy Orders Progress Notes Community Physician Orders Progress Notes Updates to POC Recertification Home Health Agency Collaborates ALL documentation with ALL other entities Home Health Collaboration of Documentation The HHA and physician who will be following patient s care in community should receive the following documentation from referring physician/facility in a timely fashion, in an effort to provide an efficient and effective initial start of care visit: for HH Services encounter Documentation Initial POC Supporting the *Homebound Status Supporting the *Need for Skilled Service &/or Recertification Statement 20 Refer to Medicare Eligibility slide #7 Home Health FTF encounter Timing Requirement Timing requirements for in-person encounter .