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Selecting (and defending) the primary diagnosis

In Blog, ICD-10 by Lisa Selman-HolmanLeave a Comment

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 …

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Medicare temporarily expands coverage of telehealth services

In Blog, COVID-19 by Lisa Selman-HolmanLeave a Comment

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 …

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AMDA Considerations to Consider Before Implementing Universal Testing

In Blog, COVID-19 by Mary MadisonLeave a Comment

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 …

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Part 2: Meeting the F2F Challenge

In Blog by Lisa Selman-HolmanLeave a Comment

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 …

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YES! COVID-19 can be coded based on a positive lab result

In Blog, COVID-19 by Lisa Selman-HolmanLeave a Comment

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 …

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Part 1: Meeting the F2F Challenge

In Blog by Lisa Selman-HolmanLeave a Comment

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 …

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CARES Act Provider Relief Fund

In Blog, News by Lisa Selman-HolmanLeave a Comment

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 …

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Initial Visit and SOC Comprehensive Assessment – not the same thing!

In Blog, News by Sarah Bacon1 Comment

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 …

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CLARITY for Home Health Agencies

In Blog, COVID-19, News by Lisa Selman-Holman8 Comments

Annette Lee, RN, MS, COS-C from Provider Insights, Inc. has provided more clarity for home health agencies during this time. Read the full summary below. So, last night, CMS published a “Fact Sheet” of additional blanket waivers and flexibilities provided to the home health industry.  Immediately, we all heard different interpretations. Today, like many of us, I spent the day reading the …

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Interim Final Rule on Homebound

In Blog, ICD-10, News by Lisa Selman-Holman1 Comment

Interim Final Rule on Homebound CMS-1744-IFC Per sections 1814(a) and 1835(a) of the Act, an individual shall be considered to be “confined to his home” if the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid …