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[HOME] [CONTACT US] Jan 4, 2001: see new look of the pms5 UFO available on the handheld, the desktop and the web. More classes opening Up, sign up Now before its too late   10-27-2000  10/27/00: The rubber meets the road next week. HCFA's PPS phase-in plan is set to end on Tuesday. From that point on all RAPs and final claims will be case-mix adjusted. Find out the effects the case-mix adjusted RAPs will have on your agency and your bottom-line, plus gear-up for the next stage of PPS --November 29th--the day you must submit your first batch of PPS final claims, when you attend the pms5 PPS Beyond the Fundamentals Summit, November 14, and Dec 5. 10/18/2000: tidbit Check those ICD-9s Make sure your clinicians and billers are inserting the full five-digit ICD-9 codes, if all five digits are available. The RHHIs won't accept three- or four-digit codes if there's a five-digit code on the books.   10-19-2000: Clarification of Policy # 99H-021-L - Physical Therapy for Home Health [Hot Topic Article]

HOME CARE WIRE
September 8, 2000

* PPS Phase-In Plan Devastates NYC, CA Agencies
* HCFA Issues Corrected HAVEN Software
* HCFA Reopens Appeals Rule Comment Period
* Hospital Companies Ditch Home Care Units

Please feel free to forward this message in its entirety to interested
friends and colleagues.

PPS PHASE-IN PLAN DEVASTATES NYC, CA AGENCIES

New York City, NY, (Eli Research) Home health agencies in New York
City will see up to $20 million less in prospective payment system payments
in October, thanks to the Health Care Financing Administration's PPS
phase-in plan, released Aug. 31, says the Home Care Association of New York
State. Oakland, CA HHAs expect $519 less per patient under the plan, adds
the California Association for Health Services at Home.
Under the plan, Medicare will pay agencies' requests for anticipated
payment (RAPs) with a standard episode amount of $1,269.18, unadjusted for
wage index or case mix category. Agencies must submit a letter requesting
the phase-in payments.
HCFA also will offer a one-time contingency payment to agencies
whose computer systems render them unable to electronically submit RAPs or
claims. HCFA's program memo outlining the phase-in and contingency plans is
at http://www.hcfa.gov/pubforms/transmit/A0059.pdf.

HCFA ISSUES CORRECTED HAVEN SOFTWARE

BALTIMORE, MD, (Eli Research) In yet another last-minute change,
HCFA corrected "several bugs" in the HAVEN grouper software, including a
failure to award points for diagnosis if HHAs entered five-digit diagnosis
codes where only three-digit codes were required for MO230.
HHAs must install the corrected grouper, available from
http://www.hcfa.gov/medicare/hhmain.htm, before using HAVEN 4.0 to generate
HIPPS codes for prospective payment system billing.
Agencies whose vendors used the grouper software to develop their
own PPS systems may not have such a simple solution, however. If the vendor
can't correct the bugs immediately, agencies should enter the diagnosis
codes exactly as shown in the PPS final rule, HCFA says. After Nov. 1,
agencies must use updated software.

HCFA REOPENS APPEALS RULE COMMENT PERIOD

BALTIMORE, MD, (Eli Research) HCFA is reopening the comment period
on its proposed rule that would extend appeal rights for suppliers whose
Medicare billing privileges are revoked, according to the Sept. 6 Federal
Register. The new comment period for the rule ends Jan. 4, 2001. The rule
also applies to physicians, HCFA clarifies.

HOSPITAL COMPANIES DITCH HOME CARE UNITS

PHILADELPHIA, PA, (Eli Research) Two more hospital networks have
decided they can no longer subsidize their home health businesses. Tenet
Healthcare Corp. will close its Philadelphia, PA-based HHA Sept. 11,
according to the Philadelphia Business Journal. And Seton Healthcare Network
in Austin, TX is trying to sell its HHA and medical equipment business,
reports the Austin American-Statesman.

ahhif-list@ahhif.org (AHHIF)

HCFA has gone back on its position, stated last Friday, and now says the RAP
for 10/1 episodes cannot be billed until the first billable visit is made.
What a mess -- I wish HCFA's consistency would improve. Stayed tuned for
developments as we receive them. See complete message from NAHC below. --> (in an email from Gene J. Tischer)
(Click on here for NAHC announcement on this)

HAVEN 4.0 Alert (08/25/2000)

The following is an important message for home health agencies preparing for PPS. Continued testing and vendor installation of the home health grouper software has recently identified several bugs in the GROUPER.DLL (ver. 01.02) software module that was used to develop the HAVEN 4.0 software. These are being corrected and a revised GROUPER.DLL (ver. 01.03) will be issued within several days.

Most significant of the recently identified bugs involves the program that classifies a PPS patient into a particular payment group using the information at M0230. The software uses the diagnosis code indicated at M0230 to assign a HIPPS (i.e., billing) code. Under the grouping logic as described in the PPS Final Rule, some diagnosis codes must be entered at the 4- and 5-digit level, while other diagnosis codes may be entered at the 3-digit level. If the agency chooses to enter the 4th and 5 th digits of codes where only 3 digits are required, it should still receive the points earned by the 3-digit code. However, the current GROUPER .DLL file (ver. 01.02) will (erroneously) assign points for such codes ONLY if the 4th and 5th digits are left blank. In other words, it grants points ONLY for ICD9-CM codes that are entered EXACTLY as they appear in the Final Rule. Please refer to the HCFA home health web page for more detail and the new GROUPER.DLL (ver 01.03) when available. You must have installed the new HAVEN 4.0 on your system prior to replacing the GROUPER.DLL (ver 01.02) with GROUPER.DLL (ver 01.03)

HAVEN Production Version 4.0

HAVEN now supports the OASIS 1.10 data specification, including the calculation of HIPPS codes for applicable assessments. Note that the value for M0090 must be on or after 09/01/2000 in order to successfully complete and export a 1.10 assessment.

HAVEN continues to support entry of OASIS 1.04 assessments; however, 1.04 assessments must have a M0090 value prior to 10/01/2000. Upon entering a 1.04 assessment, HAVEN checks the M0090 value. If the value is earlier than 09/01/2000, then data entry is performed with the 1.04 specification. If the value is between 09/01/2000 and 09/30/2000 inclusive, or if M0090 has not been entered yet, the user is asked whether the assessment should be converted to a 1.10 assessment. NOTE: A 1.10 assessment cannot be converted back to a 1.04 assessment.

A correction to an assessment maintains the assessment specification of the prior version, i.e., a correction of a 1.04 assessment is error-checked with the 1.04 specification rules.

HIPPS values are calculated with applicable 1.10 assessments. The user may highlight an assessment and calculate the HIPPS values from the HAVEN Management Screen, or from within the HAVEN data entry screens. When an assessment is marked complete, the HIPPS values are calculated again and stored to ensure that the correct values are associated with the final version of the assessment.

The export screen has been enhanced to display HIPPS information for each Export Ready assessment. The assessment list can be printed using the Print Assmts command button. The list can be sorted by clicking once on the displayed columns - additional clicks toggle the sort between ascending and descending order.

HAVEN now supports operation with the Windows 2000 operating system.

If a patch is required to the HAVEN databases, a HAVEN Patch screen is displayed after logging in. The user has the option to continue with the patch or exit the program. It is strongly recommended that a backup of the databases be performed prior to allowing HAVEN to perform any patches.

This version of HAVEN is 32-bit only; 16-bit versions are no longer in development.

During data entry, the HAVEN title bar displays the specification version in effect for that assessment (e.g., 1.10 Specification).

The HAVEN Import function now supports the import of both 1.10 and 1.04 assessments.

HAVEN 4.0 should be installed directly over the previous version. Removal of previous versions is NOT recommended before installing HAVEN 4.0 as this would result in the loss of collected data.

If you received a CD copy of HAVEN in the mail or you requested that you be put on the update list, you will automatically receive HAVEN 4.0 production version beginning in the middle of August.

Scheduling OASIS Follow-up Assessments

The OASIS follow-up (recertification) assessment completion date (M0090) must be set within a five-day window that ends 60 days from the start of care date (M0030). The date in M0090 must be one of the five days between day-56 and day-60 from the date in M0030 (which is counted as day-1).

A second OASIS recertification assessment must be completed within a 5-day window ending 120 days from the start of care date. The OASIS assessment completion date (M0090) must be between day-116 and day-120 from the start of care date. The second recertification is NOT scheduled based upon completion of the first recertification assessment.

To assist the assessor to determine the appropriate dates to schedule the first and two subsequent recertification OASIS assessments, a calendar has been developed using a Microsoft Excel spreadsheet. The spreadsheet, OASIS Calendar.xls, presents four sets of columns. The first set of columns represents the patient's start of care date. The next three sets provide the dates to use to schedule three subsequent recertification OASIS assessments. The recertification columns contain the first and last permissible recertification completion dates.

Please click OASIS Calendar.xls to download the Microsoft Excel spreadsheet. To use the spreadsheet to create an annual calendar of start of care dates and related recertification dates, enter the desired four-digit year in cell B4 of the spreadsheet. For example, to produce a calendar for the year beginning January 1, 2001, enter "2001" in cell B4 (without the "quote" marks).

PPS for Clinical Supervisors Slides and Manual

Ethical dilemmas, training staff and case-mix adjusters are just a few of the challenges you face with PPS. With your copy of the comprehensive PPS for Clinical Supervisors conference tape series and manual you'll hear case-mix analyses, care plan re-engineering, staff training strategies, and more from the country's most respected clinical experts such as top Chris Galan RN,and others, just to name a few. Lay the groundwork for a smooth transition to PPS and continued clinical success far into the future.

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