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Posts tagged ‘hospice’


I admit that I was a little hopeful, if not disillusioned, when the new UPICs came to my attention.  After verifying that UPIC was not a ZPIC with a typo, I thought that maybe this was a special type of audit where you got to pick the charts you wanted to be reviewed like some people pick their own lottery numbers.  No such luck, I’m afraid.

UPICs are Unified Program Integrity Contractors.  UPICs will carry out program integrity functions for Medicare Parts A, B, Durable Medical Equipment Prosthetics, Orthotics, and Supplies, Home Health and Hospice, Medicaid and Medicare-Medicaid data matching[i].  The primary objective of the UPIC is to identify fraud and abuse and make appropriate referrals.  Other agencies recoup overpayment and address recommendations to law enforcement addressing criminal or civil charges.  They can also recommend suspension of payment.  Whether or not the agency is notified in advance of the payment suspension depends on if the UPIC thinks it is possible that the provider will change it’s billing habits if it knows that payment will stop.  Think about that for a minute.  Who wouldn’t change their billing habits if they knew payment was coming to an abrupt halt?

UPICs, like ZPICs can request clinical records, verification of licensure, copies of claims, etc.  The most recent UPIC request I read included a host of new horrors that may not be available and/or are too cumbersome to send.   Here’s a short recap of some of the new things but remember, they can always ask for more or even go to your office to visit.

  1. Copy of the face sheet. I have never used this term in home health or hospice, but it is basically patient demographics and insurance information.  People who have experience in a hospital are likely familiar with this term.
  2. Copy of Medicare card and state identification card (driver’s license or state ID). The logistics of getting a copy of the Medicare card and state identification card involve too many opportunities for loss and theft that I don’t recommend it even if Medicare wants it.  However, Medicare and other payor sources lose money daily when somebody loans (rents) their Medicare/Medicaid card to someone else.  Some software systems allow you to post a picture of the patient on the face sheet.  DNA and fingerprints are not necessary, but the end of the earth is not too far to go if there are any doubts. 
  3. Authorization of benefits. This is almost universally included in the consent form given to patients.  Take a quick look and ensure that somewhere on the consent it says that the patient or representative authorizes the agency to bill Medicare for services.  It would hurt a lot if this statement was inadvertently omitted when all those changes were made to the form relative to the new Conditions of Participation.
  4. EHR Audit Trails. In most systems, these audit trails are cumbersome to obtain and require someone to print or save the audit trail for each individual document.  In one system, the audit trail can be over 100 pages for a single document.  For a long time, there was a vendor who provided audit trails on request, but the agencies were not able to run them.  If you get a UPIC, consider the burden to your agency and call the person who signed your UPIC letter.  It kind of makes paper charts seem appealing again.
  5. OASIS to include the start of care, the resumption of care certification prior to and after the dates of services noted in this request and the discharge. I’m not entirely sure what this means.  To the best of my knowledge, patients aren’t certified after Resumption of Care unless the patient was in the hospital at the end of the episode and there is no change between the recertification assessment (not mentioned) and the ROC HIPPS code.  If an agency has a reasonable hospitalization rate, this is a rare occurrence.  Plus, there are numerous other bullets in the list that mention OASIS assessments.
  6. Travel Logs. Some agencies don’t have travel logs.  Some don’t pay mileage and others pay a flat ‘trip fee’.  I would think a visit log would be more useful to the UPIC but in the two page request, that wasn’t mentioned.

There are many more entries in the UPIC request but even though the length of the list is daunting, it is repetitive.  Laboratory results are requested on page one and all diagnostic tests are requested on page two.  There are individual entries for all hospital documentation, Inpatient records, Inpatient records to support start of care, inpatient records for hospitalizations during the episode, emergency room visit notes and the history and physical.  The best advice I can give is to be careful when delegating the tasks on the list, so you don’t have multiple employees all printing OASIS assessments.

The good new is that most of you will not find yourself in the undesirable position of being the target of a UPIC. If you are one of the unlucky ones, well, it’s not luck that brought you the unwanted attention from a UPIC.  The data analytics are very sophisticated and there is nothing random about the selection of charts (which makes me wonder why a copy of your Medicare Census is included in the list of documents required from the agency.  They know who your patients are.)

That doesn’t mean that your agency is operating outside of coverage guidelines.  It does mean that cloned notes, poor coding, lack of OASIS skills and care plans that are copied from one episode to the next will be under the spotlight.  This results in paying money back to Medicare and additional scrutiny which may extend to your referring physicians who might then begin referring patients to your competitors because they don’t like attention from Medicare any more than the rest of you do.  I do not like it when care is provided to eligible beneficiaries gets denied because a nurse is a little too eager to show off his or her new cut and paste skills.  It’s not like the agency can recoup their paychecks.

Questions?  Comments?  Do you have any experience with UPICs?  Post your comments below or email us.  We need to know now so we can understand them before they become obsolete.

[i] From Noridian Healthcare Solutions

Guess What Happened!


Image of the Flu virus courtesy of the CDC.

Guess what happened this past weekend?  The flu season officially started.  Although most people don’t like the flu season, the advent of flu season is better news than the LSU homecoming game score.  Someone should invent a vaccine for the malaise that oozes out of Tiger Stadium and infects the entire state of Louisiana when LSU loses a game deliberately stacked in their favor.  Where is Les Miles when you need him?  I’m not even sure where Troy is.

Back to the flu.  Last year’s flu season certainly wasn’t the worst we’ve seen but an estimated 71,000 flu related hospitalizations were prevented because people received the flu shot.  Is your hospitalization rate high?  Lower it with the flu vaccine.  A full 2.5 Million MD visits were prevented because people received the flu shot.  That’s about equal to the population of the state of Oregon.

We know that Medicare doesn’t give away stuff for free so have you asked why there is no charge for the vaccine?  The total number of hospitalizations for the flu each year runs about 200,000.

And yet, in home health and hospice, our hands may be tied depending state specific pharmacy laws.  In Louisiana, you have to figure that if LSU can’t beat Troy at our homecoming game, we are likely worthless against a deadly virus that kills between 3,000 and 50,000 people each year depending on the severity of the flu season.   Because most states do not allow nurses to carry medications that are not labeled for individual patients, multi-use vials are not allowed to be carried by nurses just in case a patient is in the mood for a flu shot.  While getting an order is not difficult, many nurses are not comfortable with injecting someone with the vaccine without having an emergency kit available for a possible reaction and it is impractical and wasteful to carry around a patient specific emergency kit for every flu vaccination given since it won’t be used.

According to the World Health Organization, for every 500,000 vaccinations given, someone will go into anaphylaxis (a condition causing the inability to breathe kind of like the way Louisiana residents gasped for air after Troy beat LSU on Saturday Night).

There is also a small but significant risk of coming down with Guillain-Barre’ after the flu vaccine.  Although this is one of the more undesirable effects of the vaccine, many people don’t realize that the flu causes more cases of Guillain-Barre’ than the vaccine.  So, roll the dice.  Get no vaccine and hope you don’t get the flu or get the vaccine and have a tiny chance of contracting Guillain-Barre’.  Of course, if you or your patients opt to forego the flu vaccine from your fall schedule this year and wind up sick with the flu, your chances of coming down with a pesky paralytic illness will be greater than those who didn’t get a flu shot and those that did get a flu shot combined.

So, here’s what you do.

  1. First go to the CDC Flu page.  There you will find all kinds of teaching materials for both patients and staff in multiple languages designed for various education levels.
  2. Check on your state’s regulations about the flu vaccine.  If permitted to do so, get said permission in writing.
  3. If you can’t carry flu unlabeled flu vaccine (much like LSU can’t carry a football), use this nifty widget to find out where your patients can receive a vaccine. You can even put it on your website if you want.
  4. Coordinate with your patients and physicians to get orders for patients who are truly bedbound or live in rural areas so distant that a simple trip to the drug store is out of the question.
  5. Encourage everyone in the household to get vaccinated. Leave one of those cute flyers from the CDC website taped to the refrigerator along with the list of nearby flu shot providers to reach the maximum number of family members.
  6. You can also vaccinate other Medicare beneficiaries in the household if you get orders from their physicians. (Technically, Medicare doesn’t require an order but I highly recommend that you give nobody any medication without one; especially someone you haven’t fully assessed and are unaware of their history and physical).
  7. If your agency is going to vaccinate a lot of people, consider billing for the flu shot. I have no earthly idea of how this is done but Medicare has graciously published a little info sheet for people who know what they are doing.  Note that you can only bill for patients with Part B.

The truth is that no matter what you do, the fact that Troy beat LSU cannot be changed.  But imagine if you or your patients get the flu and are too sick to do anything that takes your mind off the greatest LSU humiliation in recent history.  A situation like that could be the end zone for countless Louisiana residents.

And if you see Les Miles, tell him to come back.


Today is the last day most of us will work this week because of Thanksgiving.  I looked back over the last couple of years to see if there was any inspiration in prior Thanksgiving posts and there wasn’t a whole lot.  Medicare still seems to be working against us and we are still fighting hard to stay in the game.  We are tough and we will survive.  It’s a given.

It isn’t that I am ungrateful.  I am grateful most days when I wake up and take note of my life.  Compared to about 90 percent of the world, I have everything; a home, a family and a son with a dog I love dearly.  Who could want more?

Maybe you could want more.  Maybe some of your patients could want more.

So this year I choose to not make a big deal about all I have to be grateful for as other people are coping with illness or the loss of a loved one.  Being grateful is good.  Flaunting my good fortune in the face of others who are not so fortunate does not tell a story about me that I like.

At some point between the Turkey and the doors opening for Black Friday, maybe we should all pause and consider how we can give something to those who do not have a warm family and home to celebrate with on Thanksgiving Day.  Maybe we can give someone something to be grateful for if only for a minute.

If you live in an urban area, consider keeping some Karma Bags in your car.  Cheap, easy and versatile, if all home health and hospice nurses making home visits carried a half dozen of these, that would make for a lot of meals.  This is what I do for less than ten bucks.

Hit the Dollar Store and go through extra stuff at your house and on your desk to come up with useful things.  Consider some of the following.

Karma 1

  • Juice
  • Mints
  • Peanutbutter
  • crackers
  • Advil or Tylenol
  • Toothbrushes/toothpaste
  • A printed prayer or poem
  • socks!
  • list of local resources
  • razors
  • soap
  • canned tuna or sausages
  • stamped postcard
  • ink pens

The list is endless and I choose what goes into the bags based upon what is available and priced so I can buy multiples.

Assemble the Karma Bags in whatever handy container you have available.  I have used zip lock bags, sports water bottles (a client had some left over from previous owners with the name of an agency that was no longer in business and burlap bags from the Kraft store that were on sale.  The best part of this kind of giving is that it isn’t limited to the holidays.

karma 2

Not everyone feels their heart reach out to the homeless people.  That’s okay.  Some people are drawn to other causes and there are so many worthy causes.  I personally am useless around sick kids but that doesn’t mean that I don’t care and I am very grateful for those who can provide care and attention to them.

If you have another idea that you think could brighten the day of someone whose day really needs brightening, please share.  And if you do Karma Bags, please send us photos.

If you are someone who will be missing someone or has otherwise been disappointed by life, try Karma Bag therapy. You might find that your day is brightened as well.


Patient Dissatisfaction

What do HHCAHPS surveys really mean? Are they useful in home health and hospice? Read yet another controversial viewpoint from Haydel Consulting Services.

Read more

Giving Thanks



Wow.  What a challenge.  Thanksgiving is this week and it is only proper that I share with you all the ways we should be thankful.  I’m really struggling.

I could be grateful because I am appealing.  I spend most days at my computer appealing denials for clients.  I enjoy a good argument but the craziness of all these denials for claims for reasonable and necessary care given to eligible patients is overwhelming.  Worse than the financial hit is the overall disrespect of home health and hospice agencies.  If anyone wants to feel like a criminal, all they have to do is work for a home health or hospice. So I may be appealing but I am not grateful.  I would much rather be teaching and doing something – anything – that worked towards better care of patients.  Keep that in mind if you need an inservice or two.

I could be grateful that the Face-to-Face documentation burden has been lightened but I am not.  I guess I’d rather it be lightened than not but I just got ten or so denials this morning related to the requirement.  The Medicare Contractors are going to suck dry the opportunity to withhold money from my clients – and you, too if you do not happen t be a client– until the very last minute.  The regulations taking effect in January have no effect on past denials. 

I could be grateful that more Americans than ever will be able to afford insurance with the ACA but I am not.  The law is so complicated that I think there are only a handful of people who fully understand it and they are not elected officials.  Since nobody really understands it, it has become a dividing line between democrats and republicans who are voting with their party with no idea of how it will play out.  So, no, thank you.  I am not grateful for the ACA.

This doesn’t mean I am not grateful though – even at work.  Home health and hospice have been taken on a ride these past couple of years and you survived. 

I am so very thankful that I know people who are willing to get up and drive to a stranger’s house to adjust pain medications at 3:00 am. 

I know the houses where the water gets cut off for lack of payment located next to the crack house and you find it in you to smile warmly at the patient and show them the same respect that you would if you saw a patient at a $20M Manhattan apartment.

I know your kids are left without a parent during a special football game or school play because you cannot leave a patient in need but I am grateful for the lessen you are teaching to the next generation.  Taking care of others is an important job.  Compassion is a value that should be passed along to the next generation.

I am thankful for those of you who contribute to this blog and The Coders’; even when I don’t agree with you.  I appreciate that you have ideas you are willing to call your own and speak up about them.  You are prime material for patient advocacy.  I like that. 

I love the laughs, the occasional tears and how you make me feel as though I am one of you.  Because I am.

Thank you.

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