HCA this week submitted comments in strong support of long-sought proposed changes to the state’s physician order and billing deadlines for home care. Our comments are at https://hca-nys.org/wp-content/uploads/2016/04/DOHsProposal_90DayPhysicianOrderFlexibilit-March28.pdf.
These proposed changes, initiated and drafted by HCA, have been a long time in the making, and HCA this year succeeded in getting the Department of Health to consider these vitally needed changes. The proposal would align the state’s deadlines with the broader timetables allowed under Medicare. The proposed changes were further recommended and advanced by the Home and Community-Base Care Workgroup. They would apply to CHHAs, LHCSAs and LTHHCPs.
As HCA President Joanne Cunningham said in a statement to Crain’s Health Pulse in February, when the proposed rule was posted, “We appreciate the state’s support for a sensible timeline that has worked under Medicare. This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.”
The proposal has been extensively reported to the membership. What follows is a summary of the current requirements and what the new proposal does.
Current requirements
Providers currently must obtain signed physician orders within 30 days of the start of home care. Meanwhile, state regulations require a provider to obtain these orders prior to billing, and the state’s billing system itself does not allow for claims to be submitted after 90 days of the service date.
“This leaves providers with a double-jeopardy situation,” says HCA Vice President of Finance & Management Patrick Conole in this week’s formal comments: “First, a 30-day window for [physicians] to provide their signatures … and second, a total 90-day deadline from the service date to have the physician signature and, following, the preparation submission of the claim for billing.”
No exception code currently exists to allow for home care billing after the 90-day window in cases where the physician signature is obtained late, even with the due-diligence of the home care provider to get the signatures timely.
What the proposed rule does
This proposed rule aligns with Medicare, requiring the signature prior to billing; Medicare allows a one-year window to bill. The rule will be joined by a separate, anticipated guidance for a new exception code allowing home care agencies to bill after 90 days when the physician signature is not obtained in that time.
Further recommendations
HCA expressed strong support, and also made three additional recommendations. The first calls on the Department to accelerate its issuance of the separate guidance allowing for a billing exception code when signatures are not received in the 90-day billing timeline, allowing for flexibility on the billing end that is commensurate with the flexibility allowed on the physician signature end of the equation.
Secondly, we also request that the Department work with the Office of the Medicaid Inspector General to incorporate the rule change in its documentation for compliance assumptions, audit standards and procedures. Thirdly, we reiterate our call for home care health information technology support to allow for better record exchange between home care and physicians for orders and other coordination.