Assessing medical necessity and homebound status of psychiatric patients

Medical Necessity
The proof of medical necessity strictly relies on the MD documentation and diagnosis and the SN’s clinical documentation during evaluation, on routine nurse’s notes, and on recertification. This is why the use of standardized tools and specific psychiatric addendum notes is an important part of the patient’s evaluation and treatment in continuing to justify medical necessity. Most psychiatric home health care falls in the observation and assessment category of nursing care. The following is …

CMS releases finalized home health PPS rule

The Center for Medicare & Medicaid Services (CMS) has released the finalized prospective payment system rule for 2017. The final rule cuts Medicare reimbursement to home health agencies slightly less than the proposed rule did earlier this year—now by $130 million as opposed to $180 million.
The final rule implements the fourth and final year of rebasing (the CY 2017 rebasing adjustment to the national, standardized 60-day payment rate is -$80.95) and implements updates to reflect …

NAHC issues lawsuit against CMS for pre-claim review and starts ‘Project 100’

The National Association of Home Health & Hospice (NAHC) has filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) over what NAHC calls their “failed pre-claim review experiment.”
While CMS has put a current hold on pre-claim review, it is still scheduled to eventually pilot in four other states. NAHC president Val Halamandaris called the lawsuit a last resort at the NAHC annual conference in Orlando, Florida this past Sunday.
NAHC legal counsel told …

Authors of study suggest framework for optimizing home health value

The final report from the Alliance for Home Health Quality and Innovation (AHHQI)’s Future of Home Health Project was published online this month in the peer-reviewed journal Home Health Care Management and Practice. The article, “The Future of Home Health Care: A Strategic Framework for Optimizing Value,” outlines a plan for home health and home-based care and recommends a framework for the Medicare-certified home health agency of the future.
The authors state that home health agencies …