April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

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Medicare ForumDo you have a Medicare question or topic that you would like addressed in the Home Health & HospiceMedicare A Newsline? If so, fax it to the Provider Outreach and Education (POE) department at 515-471-7584, or e-mail it to ianewsline@cahabagba.com. Please include your facility’s name and provider number,your name and telephone number. Responses to the inquiries received in this e-mail box will be providedonly through the Medicare Forum article, if appropriate. If you need an immediate response to a question,please contact a Customer Service Representative (CSR) for assistance by accessing the “Contact Us” pageon our Web site and select “Phone Us”. We also welcome your comments or suggestions on thispublication and other Cahaba GBA, LLC customer service activities.Q1. Can a patient continue to receive homecare and go to a Partial Hospitalization PsychiatricProgram? The patient is going 5 days a week for 4 hours a day. Does this become a homeboundstatus issue and should the patient be discharged?The only regulation we can find is in the Medicare Benefits Policy Manual Chapter 7, §30.1.1which states: Any absence of an individual from the home attributable to the need to receivehealth care treatment, including regular absences for the purpose of participating in therapeutic,psychosocial, or medical treatment in an adult day-care program that is licensed or certified by astate, or accredited to furnish adult Day-care services in a State should not disqualify anindividual from being considered to be confined to his home.A1. A patient may leave the home for health care treatment, and still be considered homebound. Thesetreatments may include dialysis, physician visits, wound care clinics, adult day care, or even PartialHospitalization Programs (PHPs), as long as the patient still meets the other criteria of homebound, andthese are fully documented in the patient’s medical record. It becomes much more difficult to supportthat a patient has health characteristics and limitations that would regularly confine him/her to theirhome when the patient leaves home for a treatment like PHP. The absences are routine, and the levelof activity in PHPs are routinely more than most homebound patients would be able to tolerate orparticipate in. A PHP includes clinically recognized therapeutic interventions, including group andfamily psychotherapy sessions, occupational, activity, and psychoeducational groups pertinent to thepatient’s illness. The medical record would need clear, strong evidence of the taxing effort it takes toleave the home in objective terms, describing the pain, dyspnea, poor balance, or other limitations.Q2. Does this mean that the patient can leave the home on a regular basis for therapeutic,Psychosocial or medical treatment that is provided in an adult day-care center only? Is thetherapeutic and psychosocial treatment separate from the medical treatment in the adult daycarecenter or are all 3 services only allowed if they are provided in an adult day-care center?The way we are reading this is that the therapeutic, psychosocial and medical treatments can beprovided on regular basis if they are being provided in a certified day-care center only. Are weinterpreting this correctly?Home Health & Hospice April 1, 2010 45Medicare A Newsline Vol. 17, No. 7
A2. Yes, you are correct. The language cited above in the Medicare Benefit Policy Manual, §30.1.1 isspecifically referring to adult day care. Absences from the home for other health care treatment arealso allowable, as long as it is clear the taxing effort, and inability for the patient to leave home isdocumented in the medical record.News from Cahaba for Hospice ProvidersNew Summary of Hospice Changes Quick Reference ToolA new quick reference tool, “Summary of Hospice Changes” is now available on our Web site. Because ofthe variety of changes affecting hospice billing, this tool is a helpful resource for hospices to learn abouteach of the Change Requests (CRs) and their specific requirements. The four page tool will assist hospicesin determining the specific billing requirements and the effective dates for each CR. Please ensure that theappropriate staff is aware of this tool. This tool is listed under “Hospice General Tools” on the “HospiceQuick Reference Tools” Web page.Clarification on Reporting of Social Worker Phone Calls by HospicesThe Centers for Medicare & Medicaid Services (CMS) issued a Question and Answer (Q&A) on their Website clarifying previous instructions provided in Change Request (CR) 6440 about reporting social workerphone calls. CR 6440 states that “social worker phone calls made to the patient or the patient’s familyshould be reported…” However, CMS issued Q&A #9970 which further expands the reporting of socialworker phone calls. In addition, the CMS Q&A also changes our previous education, which was providedin the March 1, 2010, Home Health & Hospice Medicare A Newsline article, “Common Questions and NewReason Codes for Change Request 6440” (page 33). The entire CMS Q&A is listed below for yourreference.Q: In CR6440 CMS wrote that: “Report only social worker phone calls related to providing and orcoordinating care to the patient and family, and documented as such in the clinical records.” Doesthis sentence mean that only calls to the patient and family are to be considered for reporting?A: Because of the nature of a social worker's job, social workers perform a portion of their work withoutface-to face contact with either the patient or their family, which is why CMS allowed social workers torecord their phone calls as visits. For instance, off hours counseling of the patient and/or counseling offamily members who live out of town, would be considered appropriate and necessary when providedvia a phone conversation. However, it would be inappropriate to record every phone call that a socialworker makes on behalf of a patient.Home Health & Hospice April 1, 2010 46Medicare A Newsline Vol. 17, No. 7
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Page 3 and 4: H1N1 Influenza ImmunizationsMedicar
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April 1, 2010, Home Health & Hospice Medicare A Newsline - CGS

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