Posts Tagged ‘OASIS-C’

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A Validated falls Risk Assessment from the Missouri Alliance

Friday, October 12th, 2012

Finally, a validated falls risk tool that is multi- focal and that no longer requires an accompanying single focused tool such as a TUG or Tinetti,

NAHC stated recently that home health agencies have struggled with inadequate falls risk assessment tools since the beginning of OASIS-

The Missouri Alliance for Home Care (MACHO) has recently released the validated multi functional falls risk assessment tool (MACHO-10). Per the Alliance, home health agencies now have a single tool for the OASIS requirement.

Per the Missouri Alliance, related to OASIS item M-1910, the OASIS-C Guidance Manual specifically states: “The multi-factor falls risk assessment must include at least one standardized tool that 1) has been scientifically tested in a population with characteristics similar to that of the patient being assessed and shown to be effective in identifying people at risk for falls; and 2) includes a standard response scale. The standardized tool must be both appropriate for the patient based on their cognitive and physical status and appropriately administered as indicated in the instructions.” It further goes on to say: “An agency may use a single comprehensive multi-factor fall risk assessment tool that meets the criteria as described in the item intent.”

The MACHO Home Care Fall Reduction Initiative states their initiatives aim to:

Reduce falls

Improve patient outcomes

Establish a baseline of falls in home care

Each quarter,  MACHO compiles fall data submitted by participating agencies and returns to the agencies both individual agency data analysis as well as collected data analysis of participating agencies as a whole.

The data is “meant for clinicians to use to report and track outcomes, identify trends, and improve care.” 

Now agencies can use one comprehensive validated tool to complete their assessment. However, some agencies state, that since therapy will more than likely use a TUG or Tinetti, the skilled nursing SOC will utilize the tool to be used by therapy so an admission baseline is established.Some agencies prefer an active gait and balance evaluation. It can now be a choice. 

Please go to the site below to view the exact tool

http://www.homecaremissouri.org/projects/falls/documents/Oct2012FINALValidatedFallriskassessmenttool.pdfbb

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ICD-10: An Overview Are You Prepared? Part 1

Thursday, August 16th, 2012

The implementation date for ICD-10-CM has been pushed back one year to October 1, 2014, but it doesn’t mean you have a lot of time. If you have not assessed, through a Gap Analysis, the impact of ICD-10 on your organization, you should be planning that event…soon. There is a lot to do.

 Consider organizing an ICD-10 Transition Team. That team should have a project leader.

One of the first tasks of the team is to conduct an overview of ICD-10, identify the differences between ICD-9 and ICD-10, as well as the changes soon to come.

 The ICD-10-CM Manual is available in both a print and an electronic version. It will provide the classification system that identifies diagnoses and injuries. Acute care procedures are not included in ICD-10-CM as they have been provided in a separate classification system called ICD-10 PC, so they are not a focus of home care.

 The Transition Team needs to understand that all entities covered by HIPAA, per the American Recovery and Reinvestment Act (ARRA) who conduct healthcare transactions must comply with ICD- 10 requirements.

 Per CMS, every day it pays 4.4 million claims totaling  $1.5 B. Each month, Medicare receives 19,000 provider enrollment applications. Each year, Medicare pays over $430 B for 45 million beneficiaries. Each year, Medicaid nationally pays 2.5 billion claims for 54 million beneficiaries in 56 states and territories. ICD-10 is expected to assist in cost savings as well impacting fraud and abuse. Because of the specificity of ICD-10, more sophisticated algorithms are designed to hone in on questionable combinations of codes coupled with OASIS answers to spot potential fraud.

 What is the rationale for ICD-10?

 - ICD- 9 is 30 years old and no longer has code space for new diagnoses or new conditions and treatments.

 - ICD-9 is not always precise or unambiguous.

 - US mortality data is being reported in ICD-10

thus making international comparison of mortality and morbidity difficult.

 We need more coding specificity!

- Accountable Care Organizations, Patient Centered Medical Models, Guided Coaches, etc will require more discreet data.

- Benchmarking and quality measurement require more detailed codes

- Reimbursement will require detailed documentation reflected by codes that portray accurate patient conditions

- Increased specificity in data means more robust design of algorithms to predict outcomes and care

- Increased coding detail offers the capability to find previously unrecognized relationships in  

  disease as well as variables

- Increased capability to measure healthcare quality, safety, and efficiency

- Space to accommodate future advances and expansion

- Improved capability to determine disease severity for audit risk and adjustment

 The primary physician or specialist must establish a patient’s diagnosis. A nurse or therapist will document all pertinent diagnoses on the OASIS-C and the Home Health Certification and Plan of Care (Form CMS-485). New or additional diagnoses that the clinician identifies at the assessment must be verified by the physician before the diagnoses may be added to the patient’s medical record. For ICD-10, nothing changes other than greater detail availability via codes.

 At first glance, trying to use the ICD-10-CM Manual may seem overwhelming. In ICD-9-CM, there were approximately 14,000 choices for codes. In ICD-10-CM, there are  approximately 68,000 choices. Codes exist for so many injuries, including W61.11XA biting by a macaw, initial encounter or W61.11XD biting, subsequent encounter or codes for bites by a parrot, a goose, a turkey, or a chicken. All in all nine codes for each animal and there are a total of 312 animals. There are even separate codes for a turtle as one may be “bit by a turtle” or “struck by a turtle.” Humor aside, there are now the precise combination codes to more clearly depict the true presenting picture of the patient and their needs.

 ICD-10 CM may now have 68,000 codes but acute care procedure codes, ICD-10 PC, have increased from 3,000 to 87,000 codes. That is a phenomenal increase, but necessary, given the medical advances these past 30 years. There are expected organizational benefits from ICD-10 including administrative efficiencies, cost containment, capability for more accurate trend and cost analysis, along with improved coding accuracy and productivity.

 CMS believes that the impact on reimbursement expected, includes increased accuracy, fairer reimbursement, improved justification for medical necessity, fewer errors and rejected claims (after the initial learning curve), and reduced opportunities for fraud.

 ICD-10-CM codes may have up to 7 digits and digits 2 and 3 are numeric, digits 4-7 are alpha or numerical. The greater the specificity, the greater the number of characters required.

 A Bit of Humor

 There are so many codes including injuries incurred while sewing, ironing, playing a brass instrument, even while crocheting. There is even a code, V91.07XA, for burns due to water skis on fire. Really, quite the vision and subsequent to…what, one might ask.

 Because of the precise specificity, ICD-10 requires expertise in anatomy and physiology, pathophysiology, and diagnostics. The specificity is far greater than ICD-9 and the need to better understand finite A&P as well as diagnostics is vital. Injuries are grouped by anatomical site rather than type of injury. Another change includes sequelae instead of after effects.

 CMS plans to have a draft grouper ready by April, 2013.

 New features in ICD-10 include combination codes for a large variety of conditions, commonly seen symptoms, and manifestations. An example of a combination code includes:

E13.331 Diabetic Retinopathy with Macular Edema- other specified diabetes Mellitus with moderate non-proliferative diabetic retinopathy with macular edema.

  There are a number of expanded codes for diseases and conditions, such as diabetes, substance abuse, and injuries. Codes for post operative complications have also been expanded with a distinction between intraoperative complications and post procedural disorders.

 There will be an impact on many home health departments. In our next article, let’s discuss what preparation will be needed and the specifics needed for the Gap Analysis.

 Next article: What do we do to prepare for ICD-10: Developing the Gap Analysis

 

 

 

 

 

 

 

 

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Home Health Consumer Assessment of Healthcare Providers and Systems Survey aka HHCAHPS

Thursday, October 27th, 2011

The first letters of non- compliance notification have begun arriving to over 1300 agencies. Many agencies are complaining they had complied. What has occurred? What should an agency leader do after receipt of such a letter? Why is there such focus on this survey?

What is the CAHPS Program?

The Consumer Assessment of Healthcare Providers and Systems is designed to develop and support the use of comprehensive standardized surveys that ask customers and beneficiaries to report on and evaluate the care they received. The program is funded by and administered by the US Agency for Healthcare Research and Quality (AHRQ). For over a decade CAHPS has established principles that include identifying and supporting consumer information, adherence to scientific testing principles, comparability of data, as well as maintaining products in the public domain. (CMS, AHRQ, CAHPS).

CAHPS surveys are standardized per AHRQ in the following manner:

The Instrument is standardized in such a fashion that anyone administering the survey can ask the questions in the same way.

The protocol is standardized in that it adopts the same approach to “drawing the sample, communicating with potential respondents, and collecting the data.”

The analysis is developed in a way to minimize variations in how vendors process and interpret survey results.

The reporting uses a well-tested approach that reflects best practices in reporting.

How is CAHPS Data Utilized?

Health care monitoring agencies, such as State regulatory agencies and Quality Improvement Agencies (QIOs) use CAHPS data coupled with quality measure data to evaluate agency performance. Since 1999, the National Center for Quality Assurance (NCQA) has required CAHPS data from health plans that are seeking accreditation or when they submit data as part of the Health Plan-Employer Data and Information Set (HEDIS). Behavioral health organizations must use CAHPS data along with their ECHO survey when they are seeking accreditation. PPOs must have CAHPS survey findings completed routinely as part of their accreditation process through URAC.

The CAHPS standardized surveys are expanding into new areas of healthcare but CAHPS is not new to the business of surveys. CAHPS Health Plan Surveys are designed to be heterogeneous in population coverage.

Per CMS, CAHPS Emphasis is on Consumers and Patients

CMS believes that “consumers and patients are the best and/or only source regarding care.” They also state that CAHPS surveys do not attempt to collect information that can be gathered more effectively through other means. This overall program has been a successful collaboration of public and private research organizations that includes RAND, Yale School of Public Health, and the American Institute for Research. Together, the private and public groups are known as the CAHPS Consortium. Together, they have been instrumental in developing and testing ways organizations can use CAHPS data for quality improvement.

Can an Agency Improve their Scores Through Better Practice?

Yes, an agency not only can influence later scores, they should be aggressive in doing so. Reward clinicians when a positive comment is known. In the same regard, keep track of negative comments. Help the clinician who is perceived as lacking in customer service attributes. Review facts such as sitting with a patient for 1-2 minutes creates an image of spending time and not being in a hurry. Taking time to ask about a grandchild or a pet conveys sensitivity and caring. Sometimes, a busy very qualified clinician can have behaviors misunderstood.

Be certain that clinicians understand that research supports the fact that patients want at least a day’s notice of a visit. Timely notification scores decline if the clinician does not establish or remind the patient of the visit at least one day in advance.

Find creative ways to help patients remember their education. When I once visited a home to survey care, the patient showed the picture of the blue ribbon she had received for correctly learning how to properly administer her meds. She and her nurse had  a fun time discussing the fact that she had always wanted a blue ribbon. “Now, I have one,” she stated.” And later she challenged me. “Ask me anything about those meds,”

Patients who are visual learners may appreciate a journal to take notes or may appreciate printed information they can underline with colored markers. The important point is learning how they have learned in the past.

Return phone calls promptly (within 10-15 minutes) to obtain high scores on timeliness of response to questions.

The First HHCAHPS Letters of Non-Compliance have been Received

Over 1300 agencies have received letters notifying them that they have not satisfied the requirement for participation in HHCAHPS. As a result, these agencies are slated to have a 2% market-basket reduction in 2012. That 2% will be in addition to the 3.5% payment cut proposed by CMS for that year. In a time of fragile bottom lines, a 5.5% reduction can be onerous.

So, what should the agencies do if they receive the letter of non-compliance and they believe it was sent in error? Consider appeal! Be prompt. The letter of non-compliance has a 30 day life span for appeal. Do not miss it. Verify with your vendor that the required data was submitted timely. Ask for proof of transmission.

Many agencies that received the letters reported to NAHC that submission of data occurred. Obtain proof from your vendor of the dry run and the ongoing data submissions. Data submission guidance can be found at https://homehealthcahps.org/HHAGuidanceforDataSubRept.pdf

Some agencies believe CMS may have a glitch in the reporting system. Take no chances. Obtain proof from your vendor of submission and preserve your rights by filing the timely appeal. Be proactive. The old adage, “not to decide is to decide… is true” Decide and Act.

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The Affordable Care Act and Bundling Payments

Tuesday, September 27th, 2011

The Patient Protection and Affordable Care Act has caused much change in health care and another change is being encouraged: a Bundling Payments initiative. The Department of Health and Human Services recently announced a new initiative designed to help patients receive improved acute and post care. Physicians, acute care facilities, and other health care providers can now apply to participate in the Bundled Payments for Care Improvement Initiative. CMS is seeking assistance to test and develop four different models of payment bundling. Through this initiative, providers could select conditions to bundle and determine how payments would be distributed among providers.

The belief is that “bundled payments can help align incentives for providers to partner and work closely together across specialties and settings…” (CMS, 8/23/2011).

The CMS Innovation Center http://www.innovations.cms.gov has made available the Request for Application (RFA) for three retrospective models. The application is due November 4, 2011. To apply: http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html

Specific questions can be directed to BundledPayments@cms.hhs.gov

Per CMS, research and prior demonstration projects have shown that using a bundled payment initiative for patients with coronary artery bypass graph surgery saved CMS $42.5 million, roughly 10% of expected costs. The research was conducted at hospitals in Atlanta, Columbus, Ann Arbor, and Boston.

Bundled payments are just one part of a wide-ranging effort to improve healthcare yet reduce the cost of that care. The Accountable Care Organizations are another strategy being encouraged.

These strategies are not new. Many organizations have recognized the fragmentation that occurs in healthcare delivery. Recently, the National Quality Strategy launched a Partnership for Patients uniting physicians, nurses, other healthcare professionals as well as unions, the State and the Federal Government to offer ways to prevent hospital readmissions and improve transition between levels of care. CMS announced an investment intended over $1 billion to help drive these changes. CMS also announced their intent to invest over $50 billion over 10 years in like projects.

It appears that innovative projects to decrease fragmentation in care could be rewarded. If you have ideas, why not apply for the RFA?

To read the Affordable Care Act, go to www.HealthCare.gov/news/factsheets/deliverysystem07272011a.html

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CODING 2011: ICD-10-CM and Other Deadlines Looming

Monday, January 24th, 2011

Agency leaders know that now more than ever, coding is driving reimbursement. Agency leaders want appropriate payment and compliance. Besides coding itself, and CY 2011 changes, agency leaders need to be aware that other dates are looming in this area that can impact upon an agency’s success.

While Home Health Agencies were focusing on new CY 2011 regulations and plenty of changes, leaders need to remember that there was the change to Version 5010 for handling electronic claims. CMS will still accept Version 4010 claims until January 1, 2012. CMS expects that software vendors have been conducting internal testing so testing of the new version is now externally underway and full Level II compliance is completed by December 31, 2011.

To make this process as well as the transition to ICD-10 easier, the Coordination and Maintenance Committee has proposed ICD-9-CM coding changes be frozen, effective October 1, 2011.

“Recognizing the ICD-9-CM as a dynamic statistical tool that must be flexible to meet expanding classification needs, the ICD-9-CM Coordination and Maintenance Committee was created as a forum for proposals to update ICD-9-CM.  A representative from the National Center for Health Statistics (NCHS) and one from the Centers for Medicare and Medicaid Services (CMS) co-chair the ICD-9-CM Coordination and Maintenance Committee meetings.  Responsibility for maintenance of the ICD-9-CM is divided between the two agencies, with classification of diagnoses (volumes 1 and 2) by NCHS and of procedures (volume 3) by CMS”. (http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm).

The ICD-9-CM Coordination and Maintenance Committee’s role is advisory.  All final decisions are made by the Director of NCHS and the Administrator of CMS.  Final decisions are made after the December meeting and become effective October 1 of the following year. Official code revision packages, which are referred to as addenda, are available from this site.

The transition to ICD-10 is a major change for the industry. To better effect that transition as well as the Version 5010 to handle electronic claims, the ICD-9-CM Coordination and Maintenance Committee has proposed and accepted a partial freeze at a recent meeting. This freeze identifies:

  • The last regular annual updates to ICD-9-CM and ICD-10-CM would be made October 1, 2011
  • Limited updates to ICD-10 October 1, 2013 (ICD-10-CM is expected to be fully in use in Home Health by 2013)
  • Full regular updates to ICD-10 to be reinstituted October 1, 2014

Agencies need to be certain billing software vendors are in full testing for Version 5010 and are planning for ICD-10-CM. CMS reminds everyone that ICD-10-CM is far more comprehensive than ICD-9-CM and preparation should be underway now.  (www.cms.gov/ICD10).

What are the Differences between ICD-9-CM and ICD-10-CM?

ICD-9-CM:
17 chapters and V and E code chapters
13,000 disease codes plus V and E codes
3,000 procedure codes in Volume 3
3-5 digits in disease codes
Essentially numeric system
Codes usually do not indicate timing encounter
No differentiation between left/right

ICD-10-CM:
21 chapters- V and E codes in disease chapters
68,000 disease codes, including V and E codes
87,000 procedures codes in ICD-10-PCS
3-7 digits in disease codes
Alphanumeric system
Codes specify initial and subsequent encounters
Differentiates between the right and left
Expertise in anatomy, physiology, and diagnostics will be a must

Third Party Coding experts should already be actively into their plan for additional education of their coding teams. Some, like Select Data, have been stepping up training sessions and will be offering ongoing Anatomy, Physiology, and Diagnostic seminars to refresh and maintain currency among their credentialed experts. It may look like ICD-10 is far away but, an additional 55,000 diagnostic codes, an additional 84,000 procedure codes, and increased coding specificity to the 7th digit means increased risk for payment and more importantly, increased risk for payment retention. If your payment retention has been in question, can the MACs, RACs, or Z-PICs be far behind? Could you survive what is coming with what you have right now?

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