Our VA patients are not switching over until Fall. The situation below sounds like a nightmare.
Have a great day,
Katie
Katie Troumbly,
BSN, RN, PHN, CNML
| Home Care Manager
Grand Itasca Clinic & Hospital part of Fairview Health Services
Grand Itasca Professional Building | 111 SE 3rd Street | Grand Rapids, MN 55744
ktroumb1@fairview.org |
www.granditasca.org
Office: 218-999-1047 | Cell: 218-259-1383
From: medicarewkgp@list.mnhomecare.org <medicarewkgp@list.mnhomecare.org>
On Behalf Of Karen Peterson
Sent: Wednesday, July 8, 2020 8:33 AM
To: medicarewkgp@list.mnhomecare.org
Subject: New MHCA Medicare Workgroup - intro and a question
Good morning all!
This is my first email to the new Medicare Work Group Listserv! For those of you who are new to the group, I will occasionally send out questions or resources which seem relevant, and you are all encouraged to
do the same … it’s a great way for our group to quickly and informally interact on various topics. To see who your colleagues in this group are – the roster is available
online here.
I received this note from a NAHC listserv this morning, and am wondering if any of you have experienced this with Optum:
Has NAHC or any of the state associations had discussion with Optum re: their new policy changes?
Of greatest concern is the requirement that any re-certification assessments be performed AND submitted to Optum on Day 56 (no window provided). We nor our members have been able to make any headway yet. Optum is quoting Chapter 7 of the Medicare Manual and
indicating that because they also need to have time to process submissions, "“It is not acceptable for HHAs to wait until the end of a 60-day certification period to obtain a completed certification/recertification."
I was of the understanding that Med Advantage plans could not be more restrictive than Medicare as to rules and regs imposed on providers. Don't
they have more time than day 60 to process a re-cert as long as the agency gets it to them by then? Performing a re-certification assessment and
processing the paperwork, always on Day 56, is a logistical nightmare. What happens if the patient can't be seen until the afternoon? What if Day 56
falls on a weekend or holiday and support staff are out-of-office?
Additionally, clinical documents required for home health review and required for prior authorization must be submitted by day 21:
·
Request and justification for continued home health
·
Face-to-face if available
·
Home health plan of care signed by physician
·
Comprehensive assessment including:
·
Progress notes (as applicable):
·
RN/LPN notes
·
Physical therapy notes
·
Occupational therapy notes
·
Speech therapy notes
·
Home health aide notes
·
Medical social worker notes
Thanks for any comments or insight -
Karen Peterson
Regulatory Affairs and Advocacy Manager
Minnesota HomeCare Association
2550 University Ave. W., Ste. 350 S | St. Paul, MN 55114-1900
Direct: 651.659.1457 | Main: 651.635.0607
Toll-free: 866.607.0607 | Fax: 651.635.0043
Mission:
MHCA represents and supports Minnesota home care providers committed to high quality home care services.
Vision:
MHCA will shape the home care landscape to improve and sustain quality home care services.
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