Full Answer
When to discharge a beneficiary from a home health agency?
Discharge and Readmit for Home Health Services Home health agencies (HHAs) may discharge beneficiaries before the 60-day/30-day period of care - episode has closed if all treatment goals of the plan of care have been met.
Do you need a discharge plan for a nursing home?
It should be known to all relevant care givers and family members. When developed in a care setting such as a hospital, skilled nursing facility, home health agency, or hospice, the discharge plan should be included in the patient’s medical record. An important source of information about services is the Elder Care Locator 1-800-677-1116.
How long does it take for Medicare to discharge a beneficiary?
If discharge occurs within 2 days of the date the IM was given, no follow-up copy is required. A beneficiary may be considered discharged when Medicare decides it will no longer pay for the medical services or when the physician and hospital believe that medical services are no longer required.
What is the nursing home discharge code for hospice?
A skilled nursing facility (Patient Discharge Status Code 03 or Planned Acute Care Hospital Inpatient Readmission Patient Status Code 83) or Hospice care at home (Patient Status Code 50) or Hospice Medical Facility (Certified) Providing Hospice Level of Care (Patient Status Code 51)
What is the 3 day rule for Medicare?
The 3-day rule requires the patient have a medically necessary 3-consecutive-day inpatient hospital stay. The 3-consecutive-day count doesn't include the discharge day or pre-admission time spent in the Emergency Room (ER) or outpatient observation.
What steps should they follow after discharge from hospital?
The Post Discharge Checklist: 5 Important StepsMake a Post-Discharge Care Plan. ... Reconcile Medications. ... Schedule Follow-Up Visits. ... Ask Questions. ... Seek Support.
What is Medicare safe discharge policy?
A beneficiary may be considered discharged when Medicare decides it will no longer pay for the medical services or when the physician and hospital believe that medical services are no longer required.
What is the Medicare two midnight rule?
The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.
What happens when an elderly person is discharged from hospital?
If the person will need continued support or care after leaving the hospital, they should be assigned a case manager. The case manager will work with ward staff to make sure that the person and their family are fully informed of the next steps. The case manager will: set out the person's discharge and follow-up care.
How do you transition from hospital to home?
Discuss how you can improve the transition from hospital to home and ask questions about how you can make it safer. Understand medications, dosages and schedules. Request medication information and care instructions in printed form when possible. Ask about any special procedures and special care that must take place.
When should discharge planning begin?
It should begin soon after you are admitted to the hospital and at least several days before your planned discharge. The January 23/30, 2013, issue of JAMA has several articles on readmissions after discharge from the hospital. Know where you will go after you are discharged. You may go home or to a nursing facility.
What is a discharge policy?
According to Medicare, discharge planning is a process that determines the kind of care a patient needs after leaving the hospital. Discharge plans should ensure a patient's transition from the hospital to another medical facility or to their home is as safe and smooth as possible.
What is the discharge planning process?
Discharge planning is an interdisciplinary approach to continuity of care and a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation.
What does code 44 mean in a hospital?
A Condition Code 44 is a billing code used when it is determined that a traditional Medicare patient does not meet medical necessity for an inpatient admission.
Why was the 2 midnight rule implemented?
Instead of billing the stays as inpatient claims, they should have been billed as outpatient claims, which usually results in a lower payment. To reduce inpatient admission errors, CMS implemented the Two-Midnight Rule in fiscal year 2014.
What is occurrence span code 72?
Occurrence Span Code 72; Identification of Outpatient Time Associated with an Inpatient Hospital Admission and Inpatient Claim for Payment.
Who should contact if a Medicare discharge is too soon?
Medicare beneficiaries and their advocates who question the appropriateness of a proposed discharge from a Medicare hospital, whether the discharge is too soon or whether necessary post-hospital services have been arranged, should contact the local Quality Improvement Organization ( QIO) and file a complaint.
When a hospital determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an
When a hospital (with physician concurrence) determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an expedited QIO review. The CMS guidelines provide that the appeal for expedited review must be made before the beneficiary leaves the hospital.
What information is useful for Medicare beneficiaries and their advocates?
The following information for Medicare beneficiaries and their advocates is useful in challenging a discharge or reduction in services in the hospital, skilled nursing, home health, or hospice care setting: Carefully read all documents that purport to explain Medicare rights.
How long is an outpatient observation in Medicare?
Medicare beneficiaries throughout the country are experiencing the phenomenon of being in a bed in a Medicare-participating hospital for multiple days, sometimes over 14 days, only to find out that their stay has been classified by the hospital as outpatient observation. In some instances, the beneficiaries’ physicians order their admission, but the hospital retroactively reverses the decision. As a consequence of the classification of a hospital stay as outpatient observation (or of the reclassification of a hospital stay from inpatient care, covered by Medicare Part A, to outpatient care, covered by Medicare Part B), beneficiaries are charged for various services they received in the acute care hospital, including their prescription medications. They are also charged for their entire subsequent SNF stay, having never satisfied the statutory three-day inpatient hospital stay requirement, as the entire hospital stay is considered outpatient observation. The observation status issue has been challenged in Bagnall v. Sebelius (No. 3:11-cv-01703, D. Conn), filed on November 3, 2011. Litigation is ongoing. For updates, see https://www.medicareadvocacy.org/bagnall-v-sebelius-no-11-1703-d-conn-filed-november-3-2011/ (site visited May 27, 2015).
How to contact Medicare for Elder Care?
In addition, contact the Medicare program’s information line: 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048 for the hearing impaired).
When is an ABN required for Medicare?
When a beneficiary is placed in observation status by the attending physician, it is not clear whether the hospital is required to give the patient an Advance Beneficiary Notice (ABN) of non-coverage in order to shift liability to the beneficiary. If the service is a Part B service, but it “falls outside of a timeframe for receipt of a particular benefit,” then the hospital must give the beneficiary an ABN. See Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 6, §20.6.C.
What is the face to face requirement for Medicare?
111-148, enacted March 23, 2010), §6407. The requirement is designed to reduce fraud, waste, and abuse by assuring that physicians and other healthcare providers have actually met with potential beneficiaries to ascertain their specific healthcare needs.
How do I contact Medicare for home health?
If you have questions about your Medicare home health care benefits or coverage and you have Original Medicare, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) . TTY users can call 1-877-486-2048. If you get your Medicare benefits through a Medicare Advantage Plan (Part C) or other
What happens when home health services end?
When all of your covered home health services are ending, you may have the right to a fast appeal if you think these services are ending too soon. During a fast appeal, an independent reviewer called a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) looks at your case and decides if you need your home health services to continue.
What is an appeal in Medicare?
Appeal—An appeal is the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan. You can appeal if Medicare or your plan denies one of these:
Can Medicare take home health?
In general, most Medicare-certified home health agencies will accept all people with Medicare . An agency isn’t required to accept you if it can’t meet your medical needs. An agency shouldn’t refuse to take you because of your condition, unless the agency would also refuse to take other people with the same condition.
What do hospital staff need to know when preparing a discharge plan?
Make sure hospital staff members consider your full range of needs when creating your discharge plan. If you are returning home, hospital staff must evaluat e your need for home health care, meal delivery, caregivers, durable medical equipment (DME), and changes to your home to ensure safety.
How to prepare for discharge from hospital?
Be sure the hospital prepares you for discharge. Before you leave the hospital, staff must educate and train you and/or your caregivers about your care needs.#N#Staff should provide a clear list of instructions for your care and information on all medications you take.#N#Staff must arrange all referrals for other care, including referrals to physicians, home health, skilled nursing facilities (SNFs), hospice agencies, and DME suppliers. They should also put you in touch with community services that help with financial assistance, transportation, meal preparation, and other needs.#N#The hospital is required to provide you with a list of home health agencies or SNFs in your area that participate in Medicare.#N#You or your caregiver should be told what to do if problems occur, including who to call and when to seek emergency help. 1 Staff should provide a clear list of instructions for your care and information on all medications you take. 2 Staff must arrange all referrals for other care, including referrals to physicians, home health, skilled nursing facilities (SNFs), hospice agencies, and DME suppliers. They should also put you in touch with community services that help with financial assistance, transportation, meal preparation, and other needs.#N#The hospital is required to provide you with a list of home health agencies or SNFs in your area that participate in Medicare. 3 You or your caregiver should be told what to do if problems occur, including who to call and when to seek emergency help.
What should a discharge plan include?
Your discharge plan should include information about where you will be discharged to, the types of care you need, and who will provide that care. It should be written in simple language and include a complete list of your medications with dosages and usage information.
What to do before leaving a hospital?
Be sure the hospital prepares you for discharge. Before you leave the hospital, staff must educate and train you and/or your caregivers about your care needs. Staff should provide a clear list of instructions for your care and information on all medications you take.
Does Medicare cover post discharge care?
Review which post-discharge services will be covered by Medicare and how much they will cost. The hospital should be aware of what Medicare does and does not cover and should tell you when costs may apply. If you have another type of insurance, such as Medicaid, check which services it covers as well.
Do hospitals evaluate discharge plans?
Some hospitals automatically evaluate the discharge needs of all patients , but others do not. You, your caregiver, and/or your provider can request screening for discharge planning. When developing your discharge plan, the hospital should connect with you or your representatives and, if possible, incorporate your requests.
Does a hospital have to have a list of home health agencies?
The hospital is required to provide you with a list of home health agencies or SNFs in your area that participate in Medicare.
When aide hours exceed the nursing hours, routine home care must be billed?
When aide hours exceed the nursing hours, routine home care must be billed. Examples of counting continuous home care hours are as follows: If less than 8 hours of care was given or if death occurs before 8 hours, do not count the hours as continuous care; bill the day as a routine home care day. Medical social workers, counselors, pastoral ...
How many hours of hospice care is considered continuous care?
If within a 24 hour period, 6 hours of care is provided by a hospice aide, and 4 hours of care is provided by a skilled nurse, do not count the hours as continuous care since at least 50 percent of the total care provided was not provided by a nurse. This would be billed as routine.
What is continuous home care?
Continuous home care is to be provided only during periods of crisis to maintain the beneficiary at home. Continuous care cannot be provided in a skilled nursing facility (SNF), inpatient hospital, inpatient hospice facility, a long term care hospital (LTCH), or an inpatient psychiatric facility. A period of crisis is a period of time ...
What time does skilled nursing care end?
Care that spans midnight (e.g., 4 hours of skilled nursing care is provided from 8:00 p.m. to 12:00 a.m. and from 12:00 a.m. to 4:00 a.m.) cannot be billed as continuous care hours. Supportive Documentation for Continuous Home Care.
How often should I do supportive documentation for CHC?
Although CHC is billed in 15-minute increments, the supportive documentation is not required to be every 15 minutes. Supportive documentation should be as frequent as necessary to support continued CHC, and is suggested at least hourly. Updated: 07.25.12.
How long is a period of crisis?
A period of crisis is a period of time when the beneficiary requires the higher level of “continuous care” for at least 8 hours in a 24-hour period (midnight to midnight) to achieve palliation or management of acute medical symptoms.
Can medical social workers be counted as continuous care hours?
Medical social workers, counselors, pastoral care, and bereavement counseling by any staff member certainly may be appropriate and valuable in the home during a crisis; however, those hours may not be counted in the continuous care hours.
How long does a SNF have to give notice of discharge?
If the resident has resided in the facility for 30 or more days, the SNF must generally give the resident 30 days’ advance notice of the transfer or discharge. [36] SNFs must also conduct “sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.”. [37]
Why do SNFs discharge Medicare?
Skilled nursing facilities (SNFs) often tell Medicare beneficiaries and their families that they intend to “discharge” a Medicare beneficiary because Medicare will not pay for the beneficiary’s stay under either Part A (traditional Medicare) or Part C (Medicare Advantage). Such a statement unfortunately misleads many beneficiaries ...
What is notice issue in Medicare?
The key points are that Medicare beneficiaries are entitled to have Medicare, not the facility, determine whether the beneficiary’s care is covered by Medicare; a SNF must give a beneficiary the proper notices (in expedited and standard appeals) and provide information to the BFCC-QIO (in expedited appeals) or else it is responsible for the costs of the beneficiary’s care; and even if Medicare does not pay for the care, a resident has the right to remain in the SNF (if the resident has another source of payment).
Can a SNF evict a resident?
Such a statement unfortunately misleads many beneficiaries into incorrectly believing, not only that Medicare has decided that it will not pay for the stay, but also that a SNF can evict a resident from the facility if it concludes that Medicare is unlikely to pay for the resident’s stay. [1] . The truth is that when a SNF tells a beneficiary ...
What is post acute care transfer?
post-acute care transfer occurs when a IPPS hospital stay is grouped to one of the MS-DRGs identified in the Post-Acute DRG column in Table 5 of the applicable Fiscal Year IPPS Final Rule and the patient is transferred/discharged to either:
Does Medicare pay for transferring hospitals?
The transferring hospital is paid a per diem payment (when the patient transfers to an IPPS hospital) up to and including the full DRG payment. Medicare may pay the transferring hospital