We’ve got the latest on MACs, RACs & possible new CoPs for HHAs.

Couldn’t make it out to Los Angeles for the National Association for Home Care & Hospice’s annual meeting? Don’t despair. Homecare & Hospice News writer Marian Cannell made the trip west, and she’s got what you need to know from NAHC.

Agencies are seeing increased medical reviews and additional development requests (ADR), said Mary St. Pierre, NAHC’s vice president for regulatory affairs. Denials seem to be targeting homebound status, medical necessity and therapy visits, she told attendees during a NAHC session on regulatory issues. You can expect these to continue as focus on cost cutting increases. Reviewers expect documentation to support every visit, she said.

Strategy: Be sure your clinicians know they must establish realistic goals, have goals with realistic timeframes and clearly document the patient’s condition on each visit. In completing the OASIS assessment, don’t stop with checking boxes for the questions, St. Pierre recommends. Also add a narrative explaining any way the patient differs from the description in the box you check, she emphasized.

In addition, your clinicians need to know that even when you get an episode payment, every visit must show the skilled service provided and why the clinician needs to be there.

And appeal your denials, using the regulations in 42 CFR 430-432 to support your appeal. Also use the statute for the homebound requirements and highlight in your documentation the sections that support your position, St. Pierre advised. Look for documents to assist in appeals to be on the NAHC Web site very soon, she added.