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That Three Letter Word Again


In November of 2013, Medicare changed the ‘homebound’ policy ever so slightly. It seems that the changes were significant that they are now causing denials now that the Face-to-Face documentation denial is on the way out.

To be certain, patients who were homebound prior to the change will still be considered homebound. The difference is in documentation. Here’s how it now works.

The patient must fall into one of the two following categories:

  1. Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence
  2. Have a condition such that leaving his or her home is medically contraindicated

Nothing new there, right?

If your patient falls into the first category, documentation of the supportive devices, canes, special transportation, etc. will no longer suffice to establish your patient as confined to the home. When a patient is homebound due to an illness or injury causing the patient to need assist devices and transportation, the following must also be documented:

There must exist a normal inability to leave home; AND Leaving home must require a considerable and taxing effort.

Some of you think that because your patient is without legs and cannot see and never leaves the house unless his two brothers lift him into a specially equipped van that you have established homebound status. You couldn’t be more wrong.

After documenting all of that, you cannot expect the reviewers at Palmetto to deduce from your description that it was a taxing effort and that this was a ‘normal’ inability to leave the home.

I know a lot of you will blow me off as you usually do thinking I am going overboard again. That’s okay. Call me when you are denied and I will write your appeals for you. For a price.

When it comes to paying bills, Medicare is just saying no.

 

For those of you who are regular clients and others who want a taste of what it is like having cancer and such, read Lisa’s page. Lisa is a friend who became ill with cancer and then tragically lost the man she had lived with for eight years a couple of weeks ago. So, I am staying with her for a while in Florida. It has been eye-opening seeing how that whole healthcare thing works from the patient/family perspective. It’s also been a lot of fun. Advice is always welcome. Here’s your chance to be the consultant’s consultant.

4 Comments Post a comment
  1. Cyndi #

    I believe you are correct. Homebound status is what I would consider “Low Hanging Fruit”. I suppose we shall see in the near future!

    Like

    March 17, 2015
    • I agree and I am embarrassed for Palmetto GBA that they keep looking for reasons to not pay providers that have nothing to do with the quality of care. If you think about it, we all know who the fraudulent players are. Why can’t Palmetto figure it out and target their efforts to fraud and abuse instead of low hanging fruit so they can avoid paying legitimate claims?

      Like

      March 18, 2015
  2. alphaomegahh #

    “Some of you think that because your patient is without legs and cannot see and never leaves the house unless his two brothers lift him into a specially equipped van that you have established homebound status. You couldn’t be more wrong.”
    Spiffy. Can you give an example of what they WOULD consider a description of unable to leave home, for example, “they live in a place with no doors or windows”?

    Like

    March 18, 2015
    • I think, and could be wrong, that they are going to turn this into a grammar exercise the way that they did the Face-to-Face. If you think about the F2F denials, most of them did not question that the physician saw the patient or that the patient met the requirements. Rather, they questioned the verbiage on the form.

      In the case of homebound, some of the comments I have seen are, ‘The documentation failed to demonstrate how the patient’s condition made it a taxing effort to leave the home’. In the above example, I would attempt to avoid a denial by stating that a normal inability to leave the home exists because it is only seldom that both brothers are available to load him and his dme into the van. Furthermore, the patient is exhausted and has increased pain upon return the occasional trip the physician’s office or family member’s house when alternate care is needed.

      This is excessively wordy, I know. But if your claim is worth $2,500.00, ask yourself if you write this for that figure. I know I would. Additionally, I think that they are focusing primarily on the 485 and OASIS so without having any inside knowledge, I might document this once per episode on the 485/486 and on visit notes, shorten the explanation.

      Like

      March 18, 2015

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