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Approved-By: [log in to unmask] Content-class: urn:content-classes:message Thread-Topic: Follow-Up Information to the February 20th Home Health, Hospice & DME Open Door Forum (ODF) Thread-Index: Acgt5ydcKIc/F/9CS7iDywkt6D7o2QAAG14cAAAv938AAC1SmwAIb6SeCDXcCg0AAnsY6gK64F4VAshAbogBY9Fb/AAA2EYdBBDmEjw= References: <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> Content-Type: multipart/alternative; Message-ID: <[log in to unmask]> Date: Fri, 29 Feb 2008 07:30:43 -0500 Reply-To: CMS CMSProviderResource <[log in to unmask]> Sender: Medicare Home Health Prospective Payment Mailing List <[log in to unmask]> From: CMS CMSProviderResource <[log in to unmask]> Subject: Follow-Up Information to the February 20th Home Health, Hospice & DME Open Door Forum (ODF)Follow-Up Information to the February 20th Home Health, Hospice & DME Open Door Forum (ODF) For those of you who participated in the February 20th Home Health, Hospice & DME ODF, CMS has provided follow-up information to two (2) outstanding issues: (1) Follow-up to the discussion regarding resumption of care (ROC) and MO826 number of therapy visits: Since the NA response actually reads "NA Not Applicable: No case mix group defined by this assessment," it would be an acceptable response for a Medicare patient when the assessment will not be used to define a case mix (as in most ROC situations). Because the ROC may act as a recert, which in some cases will be used to define a case mix, at times the M0826 response will require a projected number of visits for the upcoming episode. Vendors will need to determine how to accommodate either scenario. In addition, the recent Q&A listed below may be helpful. This response will be posted publicly in the next quarterly CMS OCCB Q&A release (due in April). Question: When completing a ROC, do the clinicians mark the number of PT visits in M0826 that was originally on the SOC or do they mark how many PT visits they feel are left? CMS Response: M0826 is an OASIS item with a single use of facilitating payment under the Home Health Prospective Payment System. Typically, at the SOC (RFA 1) and Recertification (RFA 4) data from M0826 (along with other relevant OASIS items) are used to determine the payment under PPS for the current or upcoming episodes respectively. In addition to SOC and Recert, M0826 is also collected at the ROC (RFA3) time point. Typically, data from this ROC is not used for PPS payment determination and in cases where the data is not need for payment, response NA - Not Applicable: No case mix group defined by this assessment could be reported on M0826. Alternatively, providers may choose to report the total of therapy visits that have been provided during the episode to date, added to the number of therapy visits planned to be provided during the remainder of the current episode. If the ROC assessment will not be used to determine payment, then it does not matter which of the above approaches an agency chooses. While data from the ROC time point does not usually affect PPS payment, there is a specific situation in which it does; that is when a patient under an active home health plan of care is discharged from an inpatient facility back to the care of the home health agency in the last five days of the certification period. In that situation, CMS allows the agency to complete a single ROC assessment to meet the requirements of both the resumption of care and of the pending recertification. When a ROC assessment will be "used as a recert" (i.e., used to determine payment for the upcoming 60 day episode), then the ROC data will be necessary to define a case mix (payment) group, in which case the total number of therapy visits planned for the upcoming 60 day episode should be reported. (2) Follow-up to the discussion related to the wound coding question: OASIS items have specific instructions from CMS. Further clarification will be obtained by the WOCN. The definitions and response-specific instructions for each OASIS item are provided within the "OASIS Implementation Manual". A Chapter 8 Appendix D is in CMS Clearance. Appendix D will contain HHA diagnosis coding guidelines. ________________________________ February Flu Shot Reminder It's Not Too Late to Give and Get the Flu Shot! In the U.S., the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don't Get the Flu. Don't Give the Flu. Get Vaccinated! Remember - Influenza and pneumococcal vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. You and your staff can learn more about Medicare's coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf <https://webmail.hhs.gov/exchweb/bin/redir.asp?URL=http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf> on the CMS website. _________________________________________________________________________ If you have problems accessing any hyperlink in this message, please copy and paste the URL in your Internet browser. If you received this message in error, please go to (http://www.cms.hhs.gov/apps/mailinglists/) to unsubscribe to the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. Responses to this email are not routed to CMS personnel. Inquiries may be sent by going to (http://www.cms.hhs.gov/ContactCMS/). Thank you.
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