DHR Chapter 13 Home Care and Hospice Documentation

Payments for Hospice are determined within the following levels of service (357)

1. A higher payment is available during the last seven days of a hospice election ending with a patient discharge due to death 2. Continuous home care day (must be nursing care and take place at home 3. Inpatient respite care day 4. General inpatient care day

Electronic signatures (350)

HHAs that maintain EHRs MAY use electronic signatures. All electronic signatures must be appropriately authenticated and dated Authentications may include signatures, written initials, or computer secure entry by a unique identifier of a primary author who has reviewed and approved the entry

To low the growth of the industry (344)

Government initiatives have implemented moratoriums on new agencies

State Operations Manual (349)

Guidelines that provide additional directions concerning required documentation for compliance with the CoP

Value-based Purchasing VBP (354)

Provides an additional payment to the episodic standardized rate for improved outcomes. Is another potential change to the current PPS, and has been a success in the nine states that have tested the program

For Medicare-certified HHAs a discharge or transfer summary is required with the Cops

Requirements List page 368

Skilled Services Requirements for benefit eligibility (350)

Skilled Services include: - intermittent skilled nursing care - physical therapy - speech therapy Patients receiving one of these three services are ALSO elegible to receive medical social services and occupational therapy A skilled service should be medically necessary

M items in the OASIS contributes to the HHRG score (345)

The score indicates the episode payment for the 60-day period The BBA bundled all services covered and paid for on a reasonable cost basis under the Medicare home health benefit, including medical supplies, into the PPS

Signature requirements (349)

The signature of the physician is critical to the certification of the need of the services as well as the confirmation of the written orders on the plan of care. Stamped dates and signatures are NOT acceptable

Home health agencies providing Medicare home health were paid by the visit (344)

There were a 200% rise in the number of visits. To combat the rapid growth a new payment system was implemented as required by the Balanced Budget Act of 1996 (BBA)

OASIS Data are collected and completed (368)

by the qualified clinician when a patient transfers to an inpatient facility with ot without discharge Agencies are required to complete OASIS within 48 hours of the discharge or when the patient dies The OASIS data is entered using Home Assessment Validation and Entry (jHaven) software and transmitted to the QIEs HAVEN is a java-based application

The Home Health Agency Manual(349)

defines the Medicare home care beneficiary and documentation for eligibility

Data Quality Management (DQM) (346)

involve continuous improvement for data quality throughout an organization and include for keys processes for data

A Local Coverage Determination (LCD) (352)

is a decision by a MAC whether to cover specific service on MAC-wide, basis

The Health Insurance Prospective Payment System (HIPPS) code (354)

is a five-character alpha-numeric code used in the HHPPS. Is derived or computed from the HHRG, but also includes episode timing and non-routine supply scores

The Home Health Plan Care (349)

is also known as CMS form 485 Is designed to meet regulatory requirements for the physician's plan of care, although it is NOT a mandated form

Utilization outcome (382)

is another type of outcome measure: - hospital admission - hospital emergency department services - discharge to the community

The patient-need classification system, also known as Home Health Resource Group (HHRG)

is derived from responses to a standard core assessment tool known as Outcome Assessment Information Set (OASIS)

The policy manual (348)

is key to understanding how the Medicare home care benefits drive documentation requirements for patient care, home health certification, the plan of care, Medicare home care surveys, and the PPS

Interim payment system (IPS) (344)

lowered the per-visit rate and set per beneficiary caps

Medicare to provide Part A home care services (343)

must be CERTIFIED. The home health agency should meet certain standards in compliance with the Conditions of Participation

OBRA requires (376)

organizations receiving Medicare and Medicaid funds to document that home care and hospice patients are informed of their rights and they agree to their care plans

Different names of plan of care (364)

also know as : -the plan of treatment, - 485, or - orders

Inadequate transmission of treatment-related information among home care staff (383)

and between home care programs and other organizations providing patient care is Negligence risk

CHAP and TJC are (376)

are accrediting organizations

First Visit Criteria (352)

Documentation language is important The third-party payer wants to see that the client is receiving the care that the skilled professional is require to provide

Second criteria for eligibility BOTH of them (351)

- exist a normal inability to leave home, - leaving home must require a considerable and taxing effort

The number of home health agencies grew

as more care moved out of the acute hospital into post-acute settings. This growth was impeded in the 1980s as a result of increasing Medicare documentation requirements and un reliable policies

Content of interdisciplinary care plan (365)

Figure 13.3

Split percentage payment

A type of reimbursement in which payments are made for each episode period, and home health agencies receive two payments to make up the total permissible reimbursement for the episode

Beneficiaries used home health care in 2014 (343)

About 3.4 million used home health care Medicare paid home health agencies $17.7 billion for that care

Medicare Fee-for-Service (FFS) ( 348)

CMS calculates this FFS improper payment rate through the Comprehensive Error Rate Testing (CERT) Program

Payment System for Hospice (357)

CMS pays hospice on a per diem basis.

Documentation for Bereavement counseling (367)

DOES NOT necessarily have to be contained in the clinical record, but it MUST be maintained by the hospice in an organized, easily retrievable manner for a specific period

Hospice Record Content (358)

Each component of the documentation must be in compliance with payment and eligibility requirements beginning with the intake information or referral and ending with the transfer or discharge

Office of Inspector General (OIG) (347)

Each year the OIG issues a work plan that identifies potential abuses of the system The work plan can be used to target documentation improvement within the home health agency or hospice

Clinical record review (370)

May focus on completeness, but it also examines quality and utilization of services Review quarterly

Home health plans of care (364)

The Medicare CoP dictate whats is the minimally required in the plan of care, also know as the plan of treatment, 485, or orders For reimbursement purposes the physician uses the POC 485 to certify the patient's need Requirements include recertification statement indicating how long the patient will require

Services provided under Medicare in the patient's residence (343)

Under physician Plan of Care -Skilled services by nurses (RNs and LPNs) - physical therapists and assistants - speech language pathologists

Service specific probes concentrate efforts on claim with

certain HIPPS codes that indicate high-cost services

For payment the physician must (349)

certify that the patient is elegible to receive Medicare home health care services and will establish and sign an date the plan of care

Community Based Alternatives CBA (Medicare waiver program) allows (343)

- Aged - Blind, and - Disabled that require a nursing facility level of care to reside at home or in a assisted living residences instead of in a nursing home The types of service available are nonmedical in nature Personal care as coverage for - nursing services - medical supplies, - therapies, - home modifications - emergency response services - adaptive aids

Key points of the PPS for HIM professionals include: (353)

- Data documented from patient assessments will be used to support payment rates. Payment rates are adjusted by geographic wage indices - Medicare pays a predetermined base payment per episode, which is then adjusted for the health condition and care needs of the beneficiary and the geographic location - The unit of payment is a 60-day episode of care - There are adjustments for: * Outliers increased payments for costlier services * Fewer than five visits in an episode (Low utilization Payment Adjustment) * Early discharges with readmission (Partial Episode Payments) -The episode payment is split to help alleviate cash flow concerns.

Previous years (2015 and 2016) plans for both home health and hospice include (347)

- Determine whether home health claims were paid in accordance with federal laws and regulations - Determining the extent to which HHAs employed individuals with criminal convictions - Reviewing the extent to which hospices serve Medicare beneficiaries who reside in assisted living facilities (ALFs). Resident's in ALFs have the longest LOS - Assessing the appropriateness of hospices' general inpatient care and the content of election statements for hospice beneficiaries who receive general inpatient care

Hospice regulations require an interdisciplinary group to plan the care and services (357)

- Doctor of medicine or osteopathy - Registered nurse - Social worker - Pastoral counselor or another type of counselor

In the HHGM, episodes of care are placed into different subgroups for each of the following broad categories: (354)

- Episode timing (two groups): early or late, meaning the first and second episodes being early and the third or later episodes being late - Admission source (two groups): community or institutional admission source - Clinical grouping (six groups): musculoskeletal rehabilitation; neuro/stroke rehabilitation; wounds; medication management, teaching, and assessment (MMTA), behavioral health; or complex nursing interventions - Functional level (Two or three groups): If the clinical group is behavioral health or musculoskeletal rehabilitation then the potential functional levels are low or high; if the assigned clinical group is MMTA, complex nursing interventions, neuro/stroke rehabilitation, or wounds then the potential functional levels are low, medium, or high - Comorbidity adjustment (two groups): Yes or NO based on secondary diagnoses complex nursing interventions In total there are 128 possible different payment groups an episode into under the HHGM

Various factor have driven the need for improved health information management (HIM) in home care and hospice organizations (344)

- First, compliance with CoP. Home health agencies and hospices must comply with standards - Second, payment policy changed the way home health agencies provided services - Third, the advent of the standard core assessment tool OASIS

The following information will be used to find the OASIS to check against the claim so HHAs should double check this information prior submission (371)

- HHA CMS Certification number (OASIS item M0010) - Beneficiary Medicare Number ( OASIS item M0063) -Assessment Completion Date (OASIS item M0090) - Reason for Assessment (OASIS item M0100)

Dependent services (343)

- Home health aide services for the provision of personal care - medical social services, and - family of the patient ( in limited circumstances) Can only be provided when other skilled services are ordered and provided All services must be medically necessary

The OIG Work Plan 2017 includes (347)

- Identifying potentially unqualified or fraudulent providers - for Hospices, determining whether a registered nurse made required on-site visits to the homes of Medicare beneficiaries to supervise hospice aids

Home confinement (Homebound status) (350) Criteria /table 13.1

- Is one of the eligibility criteria - Second criteria: exist a normal inability to leave home, leaving home must require a considerable and taxing effort - Patients should be homebound to be elegible to reimbursement - The reasons for homebound status should be recorded as part of the face-to-face encounter documentation, on the plan of care (485 form or facsimile) - Documentation regarding homebound should be descriptive

The term Home Care encompass:

- Medicare certified home health - Privately paid home care - Personal care providers, and - Hospices

Examples of reimbursable skilled services include (351)

- Observation and assessment when significant changes in the patient's condition could occur that would require skills or evaluation of a skilled nurse and that may result in changes in the client's plan of treatment or in a possible hospitalization - Teaching and training activities that require nursing skills or knowledge - Performance of skilled procedures such as the insertion and sterile irrigation of catheter, intravenous and intramuscular injections, and wound care - Management and evaluation of the care plan

Privately paid home care usually encompasses (343)

- Privately paid home health aides - homemaker services, and - nursing Services are paid out-of-pocket, the data on prevalence or cost differs across sources

Trained staff of HIM professionals often perform quantitative record review, targets may be (370)

- Quality of care through QAPI - Presence of documentation to support skilled care - Compliance with Cops in readiness for surveys - Documentation to support eligibility as targeted by medical review contractors

Home health consists of (342)

- Skilled nursing - physical therapy - occupational therapy - speech-language-pathology - medical social services - home health aide services

The three benefits periods are (356)

- The initial 90-day period -The subsequent 90-day period - The subsequent extension of an unlimited number of 60-day periods when the patient is certifies terminally ill with a six months prognosis if the disease runs its normal course

Physician should certifies the following requirements are met (349)

- The patient needs intermittent SN care, PT, and/or SLP services (OT can initiate care) - The patient is confined to the home (known as homebound) - A plan of care has been established and will be periodically reviewed by a physician - A face-to-face encounter has occurred no more than 90 days prior to the start of care (SOC) or within 30 days after the SOC, by the physician or an allowed Non-Physician Practitioner Te face-to-face encounter must be related to the primary reason for home care

The focus of medical review on hospice claims involves (

- adequate documentation of election hospice - primary or terminal diagnosis - LOS

One eligibility criteria (351) one of them

- because of illness or injury - a condition that leaving dis home is medically contraindicated

Hospice information in the first visit (361)

- demographic information - inpatient diagnoses - initial assessment - functional limitations - mental health and emotional status

Services provided under Medicare hospice benefit include (344)

- nursing care - physical - occupational - speech-language pathology services - medical social services, and - home health aide That is were similarity with home health ends Also included in the benefit are - medical supplies - including drugs and biological - short-term inpatient care for respite care - procedures for symptom management (pain control)

Health records should be reviewed (370)

- on admission - at discharge - every 30 to 60 days to coincide with admission - 30-day reassessment by therapists - at the recertification OASIS timepoint

The improper payment rate for fiscal year (FY) 2016

- over all Medicare providers was 11% - for home health claims was 42% - for non-hospital-based hospices was 14.6% - for no documentation 1.9% - for insufficient documentation 74.2%

Legal issues in home care and hospice (376)

- patient's rights - advance directives - do-not-resuscitate - issues related to the withholding of life sustaining treatment

Additional services include (344)

- physician services - counseling (dietary, spiritual, bereavement)

The comprehensive assessment must take into consideration the following factors: (363)

- the nature and condition causing admission - complications and risk factors - fictional status - imminence of death - severity of symptoms

DQM four key processes for data (346)

1. Application: the purpose for which data is collected 2. Collection: The process which data elements are accumulated 3. Warehousing: The processes and systems used to archive data and data journals 4. Analysis application: the process of translating data into information used for an application

Required assessments by the Hospice CoP (363)

1. The hospice registered nurse must complete an initial assessment within 48 hours after the election of hospice care is complete 2. The hospice interdisciplinary group must complete the comprehensive assessment no later than 5 calendar days after the the election of hospice care 3. Initial information must be incorporated into the plan of care and considered in the bereavement plan of care

Physician criteria to determine a terminal illness (356)

1. The primary terminal condition 2. Related diagnoses 3. Current subjective and objective medical findings 4. Current medication and treatment orders 5. Information about the medical management of any of the patient's conditions unrelated to the terminal illness

Dietary and Nutritional Information (367)

A diet history and nutritional evaluation by a dietitian should be completed when appropriate as defined in organization policy

The Medicare Hospice Benefit (356)

A patient must have a physician-certified terminal illness to be elegible for hospice benefit -The certification must indicate a life expectancy of six month or less - A written certification must be obtained for each of - risk and fraud includes inadequate documentation at the time of election of benefit

Home Health Clinical Notes (366)

Ambiguity can also cause denial of a benefit claims

Bereavement Documentation (367)

Bereavement counseling services are provided on the basis of an assessment of the family's and caregiver's needs, the presence of any risk factors associated with the patient's death, and the ability of the family to cope with grief

Future enhancement of PPS (354)

CMS is currently refining the PPS due to the rising costs Have developed potentially large-scale payment methodology changes to better align payment with patient needs. The possible change includes a new Home Health Grouping Model (HHGM) to replace HHRG

The Prospective Payment System (345)

Changed Medicare home care reimbursement from a cost-based system (per visit) to a fixed-fee system for a 60-day episode based on a patient-need classification system

Clinic notes and visit documentation (366)

Clinical and visit are designed to give a clear, comprehensive picture of the patient's clinical status, the care being provided, and the patient' response to that care

Hospice clinical and Progress Notes (366)

Clinical note refers to a note documenting care services provided Progress note refers to a summary note

Home Care (342)

Consists of - services provided from 2-24 hours per day - personal-care providers (bathing and eating) - hospices * More than 33,000 providers deliver home care services to some 12 millions individuals who require services because of acute illness, long term conditions, permanently disability or terminal illnesses * More than one-fifth of home care services is paid for out-of-pocket (private)

Face-to-face encounter requirements (360)

HIM professionals evaluating the adequacy of face-to-face documentation must determine that the face-to-face encounter: (Should primarily concentrate) - occurred within the required time frame - was related to the primary reason the patient requires home health services - was performed by an allowed provider type This information can be found most often in clinical and progress notes and discharge summaries obtained from the facility or physician's office

Hospice Assessment and hospice item set (HIS) (363)

HIS files are required to be submitted to CMS via Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System

Personal care programs, supplemented by government funds (343)

Have developed to care for: - chronically ill - indigent - disable population

Patients should be essentially (350)

Homebound to be elegible for reimbursement

Hospice Plans of Care (364)

Hospices often use a plan of care similar to the home health 485 The 485 should not include a homebound statement Standardized care plans and protocols are available for provision of specific services and for medical and nursing diagnoses

General Inpatient Care (GIP) stays (347)

In 14% of GIP stays the physician did not meet documentation requirements when certifying that the beneficiary was terminally ill or appropriate for hospice care

Prospective Payment System (PPS) (344)

In PPS, Medicare pays set dollar amount per episode of care (60 days) based on the clinical, functional, and service utilization score for the patient, instead of the old per-visit method that increased utilization

HHGM payment groups (354)

In total there are 128 possible different payment groups an episode into under the HHGM Unlike the current model, the HHGM does not rely on the number of therapy visits provided

The Balanced Budget Act of 1996 (BBA) and the Omnibus Budget Reconciliation Act of 1987 (OBRA) (345)

Is a federal law that mandated the implementation of a new prospective payment system for - skilled nursing facilities, - home healthcare agencies, - outpatient rehabilitation services, and - other outpatient services provided to Medicare beneficiaries

Home Health Compare (346)

Is a set of publicly reported measures that indicate outcome measures and process measures in layman's terms using specific evidence-based processes

Home Health Agency (343)

Is an organization that provides home care services like: - skilled nursing care - physical therapy - occupational therapy - speech therapy, and - personal care All those services provided in a patient's residence under a physician ordered Plan of Care

Is Medicare home health a full-time private duty type service? (352)

Is not. For coverage of home-care benefits, skilled nursing and aide services must be provided on an intermittent or part-time basis Daily visits may continue for 21 days If daily visits continue longer than 21 days, an end-in-sight statement must be included in the plan of care

The goal (363)

Is to promote the patient's well being, comfort, and dignity throughout the dying process

OBRA's Patient Self-Determination Act of 1990 (377)

It requires home care and hospice organization's receiving Medicare and Medicaid funds to inform patients of their rights under state law Two common types: - Living wills - Durable powers of attorney

The US Supreme Court decision in June 1999 developed care for (343)

Made states provide community-based services for - the chronically ill - indigent, or - disabled population Made states provide community-based services, when: - the state's treatment professionals determine that is appropriate - the affected persons do not oppose treatment - the placement can be reasonably accommodated

Patient's rights (376)

May include -privacy rights - rights participating in planning care - financial liability, etc

The largest single payer for home-care services (342)

Medicare Other sources: - Medicaid - Older Americans Act Title XX - The Veteran's Administration (Tricare)

MAC

Medicare Administrative Contractor

Provisions of Care under the Medicare Hospice benefit and Documentation

Medicare has defined four general hospice care levels and assigned different reimbursement rates (which change annually) to each: - Routine home care - Continuous home care - Inpatient respite care - General inpatient care

Home Health Prospective Payment System (HH PPS) (352)

Medicare reimburses all HHAs under a PPS PPSs are designed to promote efficiency and help prevent waste and abuse The number of visit per episode (paid per visit) were often 80 to 100 prior PPS Under PPS, HHAs are paid a predetermined base payment that may vary per each 60-day episode-of-care depending on the patient's severity of illness

Increasingly complex organizations (346)

Mergers and acquisitions, and hospital system looking to expand into the post-acute settings, have led to Increasingly complex organizations Reliable, standardized systems for data documentation are essential end efficient methods for sharing information among providers

Medicare Hospices (344)

Must be certified to provide Part A hospice services. Certification means that the hospice has met certain standards and is insubstantial compliance with the CoP

OASIS - Standard Core Assessment tool (345)

OASIS is designed to be used by providers and by government agencies to compare patient indicators and outcomes across providers. Home health agencies can obtain a variety of reports from the OASIS data to enable the agency to conduct quality of care reviews, set in place best practices, and direct documentation quality

The Potentially Avoidable event PAE (372)

Previously known as Adverse Event Report report displays incidence rates for 12 infrequently occurring untoward events - Are available on quarterly basis - Are used by surveyors for focused reviews - Reflect a serious health decline - Can identify substandard care

Medicare Home Care Surveys (368)

Surveyors use medical, nursing, and rehabilitative care indicators to determine the quality of a patient's care and the scope of the HHA services provided to the client. These surveyors use the CMS Home Health Functional Assessment to document data Fig 13.4 and 13.5 (369)

Additional Development Request (349)

The actual clinical note by the physician must be incorporated within the home health medical record and be provided to the MAC or other contractor in the case of medical review

Consumer Directed Services (CDS) option (343)

The disabled or their advocates usually self-direct their care. When so, the care is referred to CDS option. Under CDS option, participants are given the flexibility to choose their own individual providers

Request for Anticipated Payment RAP (353)

The first payment is received once the RAP has been submitted. The RAP results in 50-60 percent of the anticipated episode payment. The remaining percentage of payment is paid at the end of the episode of care, once the final claim or end of episode claim has been submitted

Facsimile signatures (350)

The plan of care or verbal order may be transmitted by facsimile machine The HHA is NOT required to have the original signature on file But it is responsible for obtaining original signatures if an issue surfaces that would require verification of an original signature

The regulatory of documentation requirements has also grown (344)

This has challenged providers to develop information management systems that encourage documentation of standardized, high-quality, and accesible clinical data to reflect compliance with payment and eligibility requirements

To whom is home care provided? (342)

To patients that require services because of: - Acute-illness - long-term care conditions - Permanently disability - Terminal illness

Face-to-face encounter requirements for Hospice (360)

Unlike face-to-face encounters for home health agency patients, a hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient whose total stay is anticipated to.

Progress notes and the Discharge Transfer Record (367)

Upon a patient's discharge or death, a discharge summary is documented and include: - Admission and Discharge dates and type of discharge - Care and support provided by each discipline - Status of goal attained upon discharge or death - When discharge alive, the status of the patient and the reason of discharge - Discharge diagnoses or problems - Any unmet needs and referrals for continuing care - For hospice setting, time and place of death for bereavement follow-up

Recertification Statement (350)

Upon completion of every 60-day episode, the physician is responsible for home health recertification for a subsequent 60-day episode Recertification is required at least every 60 days must be included in the plan of care and signed by the physician The lack of statement may result in denials

The Cruzan decision affirmed (377)

a patient's right to refuse both - life-sustaining treatment and - life-saving treatment

Which of the following is Incorrect regarding the hospice benefit a.The patient must die within six months for the care delivered to be covered under the benefit.b.The patient's medications related to the terminal illness and related conditions are covered under the benefit.c.Risk of fraud includes inadequate documentation at the time of election of the benefit.d.Hospice care may be provided within hospitals and nursing facilities.

a.The patient must die within six months for the care delivered to be covered under the benefit.

The HIS- Admission includes

administrative information: site of service and demographic information The health condition portions includes questions: - pain screening - comprehensive pain assessment - screening for shortness of breath

MAC auditors use the OASIS (371)

as an audit tool

quality assessment performance improvement (PI) (346)

benchmarks within and among organizations

Medicare Administrative Contractors MAC (371)

combine the Fiscal Intermediaries (Part A) with the Part B contractors into MACs which cover Part A and Part B claims in geographic jurisdiction

Patient's rights New Medicare COP 484.4 (376)

confirm's a patient right to be informed about participate in - planning care - Treatment - right to be informed about to de furnished - financial liability

Comprehensive Error Rate Testing (CERT) (348)

each year CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules

Processes measures (346)

focus on a process that leads to a certain outcome, meaning that a scientific basis exists for believing that the process will increase the probability of achieving a desired outcome

Olmstead Vs Zimring 199 made community-based services (343)

for persons with disabilities who would be entitled to institutional services, when: - the state's treatment professionals determine - the affected persons do not oppose - the placement can be reasonably accommodated

Medicare began paying for hospice services (344)

in October 1983, 10 years after the first hospice was established in the US The number of Medicare certified hospice has grown from 31 in January 1984 to 4,463 as of March 2017

The Split-percentage payment approach (353)

increases the need for timely signed orders The code that provides the score indicating the payment for the episode is derived from the OASIS, so prior to submitting the RAP, the OASIS must be checked for accuracy and encoded to obtain the HHRG

Outcome measures (382)

indicate changes in a patient's health status between two or more time points, namely Start of Care and Discharge, and Resumption of Care and Discharge, utilizing those particular OASIS assessments to measure the change

One of the vulnerabilities of the PPS

is - the greater number of therapy visit provided - the greater payment - unintentionally inducing home health agencies to provide more therapy

Do not resuscitate orders DNR (377)

is a physician order documenting a patient's desire for no resuscitation attempts. It does not replace the need for that directive. "Do Not" orders include: do not hospitalize, do not treat

Plan of care (348)

is a physician's written plan saying what kind of services and care the patient needs for their health problem

Quality Assessment Performance Improvement QAPI

is a requirement of accreditation organizations, some state regulators, and soon, the new CoPs

The protection and promotion of patient and family rights (376)

is addressed by: - Community Health Accreditation Program (CHAP) - The Joint Commission (TJC) standards - Medicare Home Care and Hospice CoPs

The National Association for Home Care and Hospice (NAHC) (344)

is the largest trade and "professional association representing the interest of chronically ill, disabled, and dying Americans for all ages and the caregivers who provide them with in-home health and hospice services

Quantitative Record Review (370)

is the study of data that can be measured Should be conducted at regular intervals

Palliative care (346)

patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering

Hospice Compare allows (346)

patients, family members, and healthcare providers to evaluate the quality of hospices across the nation

Comprehensive assessment (362)

reflects the patient's current health status and includes information to establish and monitor a plan of care which must be reviewed and updated every 60 days OASIS is only required for Medicare and Medicaid patients

The General Accounting Office (344)

reported a 31.5% decline in the number of agencies between 1997 and 2001, mostly because agencies had to adjust their operational and clinical processes quickly to meet limited budgets under the IPS

The final claim for the episode (354)

requires that all orders be signed by the physician and the OASIS has been submitted to the QIES CMS and its contractors will auto-deny a claim if the OASIS for the episode is missing

Risk adjustments (362)

statistically compensates for differences in patients and patient populations within a home health agency

Hospice provide care to: (344)

terminally ill individuals

Hospice CoP require (345)

that the hospice must provide all reasonable and necessary services and management of the - terminal illnesses, - related conditions, and - interventions to manage pain and symptoms

Deemed status means that (382)

the agency or hospice has met the conditions of participation and mat be certified as Medicare provider

The Older Americans Act of 1965 (342)

the first federal level initiative aimed at providing comprehensive services for older adults (AUCD)

Medicare certified indicates that (342)

the home health agency providing services has met certain minimum standards set by Medicare

Determining care includes (377)

the right of a patient to refuse treatment - Which the US Supreme Court supported in the right to die Landmark case - The Cruzan decision

Home care agencies may contract with the state (343)

to manage operational processes such as: -supervision - training, and - payroll for those individual providers, who may be siblings, ex-spouses, friends, or children of aging parents. Clinical documentation is mostly NOEXISTENT in these non-health care settings

Hospice Item Set (HIS) a core assessment tool (346)

was also incorporated into the requirements for hospices for the purposes of obtaining outcomes data The HIS is a set of data elements used to calculate quality measures for hospice

The Outcome Assessment Information Set (OASIS) (362)

was meant to collect outcomes information. Purposes of OASIS information: - Outcomes - Payment - best practices - risk adjustment - survey

The challenge for the revisions that CMSs have recently done to CoP (345)

was to standardize assessments and develop data collection methods that providers could use as management tools

Home care agencies must comply (343)

with certain contract requirements that are usually regimented by the government payor

The OASIS is required to be transmitted (354)

within 30 days after the assessment is completed