There are a few specific guidelines that all home health agencies must follow so that they can meet the CMS electronic data requirement. In fact, according to the law, every home health care agency must report at least once in a month the OASIS data electronically on all patients to whom the care services are delivered.
From time to time it is also required to edit specifications so that you can comply with the different aspects of the regulation. Comprehensive assessment of the patients is an essential requirement as per the rule which is why every home health care agency should:
- Continue to collect the OASIS data regarding their non-Medicare or non-Medicaid patients and
- Encode and transmit this OASIS data to the relevant authority regarding the non-maternity Medicare and Medicaid patients who are above 18 years of age and are receiving skilled services.
According to the rule, the private pay patients are demarcated. Any patient that is not included into the Current Payment Source for Home Care should not fall under any of the following responses:
- Medicare or Medicaid for traditional fee-for-service and
- Medicare or Medicaid for managed care and HMO
However, if a patient carries a private pay insurance as well as an MO150 response for which the home health agency is providing and billing the services, it is required to collect the OASIS data for comprehensive assessment and transmitted.
Know the exclusions
Medicare HMO and managed care does however include MA or Medicare Advantage plans or Medicare PPO plans. The contracted organizations or home health agencies are required to report OASIS data for that matter to the State.
For this they must use specific software such as HAVEN that is provided free by CMS.
- Using software like HAVEN will enable them to conforms to the specifications of it and
- It will also help them to analyze the OASIS data reports.
Using such software, the home health agencies will also get accurate reports of the findings that will help the Home care agencies near me to identify the level of performance of their care plans and the provisions of care they offer to the patient population. The report will help them to compare the performance of theirs with others and design their care processes just as required to excel and survive the competition.
Considering all levels
The use of the specific process and software will help the home care agencies to perform well at all level, whether it is local, state, national, or international. It is all due to the ongoing survey process that will help the agencies to:
- Create and establish better care policies
- Comply with the unexpected surveys
- Include ongoing request
- Meet the specific intervals and
- Submit the current census of patients being cared for.
With all this information provided it will be easier for the payers and surveyors to conduct a better analysis and comparison of the number of patients, types of care provided and the expenses based on the data received from the OASIS State system. They can also monitor the activities of the agencies offsite if required and transmit the OASIS data to the State.
Face-to-Face Encounter
In addition to the OASIS data requirements, the home health agencies must also care for the FTF or face to face encounter. According to this the agencies are required to have the initial or Start of Care certification. In this certificate specific types of documentations and elements should be included. This will help in several ways such as:
- It will help the physician and the Non-Physician Practitioner or NPPs to have a face-to-face encounter with the patient
- Relate the main reason for the need of home health care which will play a significant role in the payment aspect.
In absence of an initial certification that is complete in all respects, subsequent episodes cannot be started. Therefore, any claims may be denied in such situations.
Time frame and other requirements
In order to make a successful claim the home health agency must also follow the desired time frame for the encounter. Typically, the home agency must ensure that the FTF encounter occurs:
- Either within 90 days before the SOC or Start of Care or
- 30 days after the SOC.
It is also required to ensure that the FTF documentation and encounter is performed by a certifying physician.
This physician should ideally have cared for the patient either in an acute setting or in a post-acute facility directly before starting the home health services and enjoyed specific privileges at the said facility.
It can also be performed by a qualified non-physician practitioner working under or along with a certifying physician. However, it is only the certifying physician who can sign on the encounter on either certification or any other addendum to it that should clearly mention the date and type of services rendered.
FTF documentation and other requirements
FTF documentation is of high importance especially after January 1, 2015. These documents may include:
- Physician certificates
- All medical records
- Acute and post-acute care records in case the patient is admitted directly to home health.
All these documents are essential to determine the eligibility of the patient to receive Medicare home health benefit. It will also help the surveyors to determine the amounts be reimbursed.
Therefore, it is required by the home health agencies to generate accurate medical records and documents. However, only documents are not enough to make a successful claim. It is also required to show that the patient is eligible for such payments and home health benefits.
The other requirements of the home health care agencies are:
- An admit summary
- Therapy evaluation and notes
- OASIS data
- Nurses’ and physicians’ notes and other documents that will support the claim.
Thee will make it easy for the physicians to authenticate the claim and incorporate other details if necessary, to support the FTF encounter. This will also eliminate the chances of any contradiction regrading the date and types of care services provided.
Therefore, to ensure that the claims are received, it should be delayed till all FTF documents and requirements are collected and met with.