Getting the right primary diagnosis can be a real challenge, and generate some lively debate among clinicians, QA managers and coders. Ultimately, we must meet the requirements for payment under the Medicare coverage and payment regulations. The primary diagnosis must be supported by documentation in three places The Face-to-Face encounter note from the physician or non-physician provider The problem(s) identified …
BREAKING NEWS: Nursing Home COVID-19 Data and Inspections Results Available on Nursing Home Compare
Below is a repost of a Briggs article written by Mary Madison, RN, RAC-CT, CDP, Clinical Consultant, Briggs Healthcare. “Today, the Centers for Medicare & Medicaid Services (CMS) is posting the first set of underlying coronavirus disease 2019 (COVID-19) nursing home data. On April 19, 2020, CMS announced the requirement that nursing homes to inform residents, their families, and their representatives of COVID-19 cases …
Medicare temporarily expands coverage of telehealth services
Telehealth is a visit with a provider that uses telecommunication systems between a provider and a patient. Medicare has temporarily expanded its coverage of telehealth services by waiving 42 CFR § 484.55(a), allowing home health agencies to perform the initial assessment remotely. The initial assessment must still be provided within 48 hours of the patient’s referral or return home from …
AMDA Considerations to Consider Before Implementing Universal Testing
Below is a repost of a Briggs article written by Mary Madison, RN, RAC-CT, CDP, Clinical Consultant, Briggs Healthcare. AMDA posted this document on May 18, 2020. Here is the issue that the document addresses: “There is a clear understanding that protecting our vulnerable post-acute and long-term care (PALTC) population is dependent on adequate access to testing. Testing must be readily accessible, completed in a timely …
Part 2: Meeting the F2F Challenge
Last week, we covered the Face-to-Face encounter documentation requirements, how to provide additional information that might be missing from the provider’s original F2F encounter visit note, and some tips from Palmetto’s frequently asked questions on RCD regarding F2F. Since many F2F encounter notes by providers (physicians, PAs and NPs) are missing some required details, agencies are usually finding it necessary …
YES! COVID-19 can be coded based on a positive lab result
Lots of folks are making statements about physician documentation linking positive test results and not being able to code based on lab results. When coding COVID-19, there are exceptions in both cases. COVID 19 guidelines Code only confirmed cases. Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider, documentation of a positive …
Part 1: Meeting the F2F Challenge
The Public Health Emergency has resulted in some changes to the face-to-face encounter guidelines, but F2F has not gone away! As agencies in Review Choice Demonstration states navigate Pre-Claim Review, Palmetto is answering questions and offering additional suggestions on meeting the F2F requirements. If you are struggling with pre-claim review in a current RCD state (Illinois, Ohio and Texas), if …
[On-Demand Webinar] Breaking Down Coding Clinic First Quarter Update
Answers, we love answers! The Coding Clinic First Quarter 2020 provided many useful updates for home health, hospice & long-term care coders, including: Coding stenosis and spondylosis at the same time Diabetic manifestations when the patient no longer has diabetes And more Follow along with Lisa as she breaks down the first quarter update, COVID-19 guidelines in detail and the …
CARES Act Provider Relief Fund
Attention home health agencies and hospices! If you see an unexpected Medicare payment from CMS this week deposited in your bank as “HHSPAYMENT”, don’t be alarmed, as these payments are not billing errors. These payments are part of the CARES ACT relief fund to help providers maintain stability during the COVID-19 crisis. CMS is sending $30 billion to all Medicare-reimbursed …
Initial Visit and SOC Comprehensive Assessment – not the same thing!
Due to the COVID-19 Public Health Emergency(PHE), CMS has waived the Home Health Condition of Participation under 42 CFR § 484.55(a) regarding the initial assessment: This change allows home health agencies to perform initial assessments and determine patients’ homebound status remotely or by record review. However, the initial assessment visit is NOT the same as the Start of Care comprehensive …