Hurricane Season Preparation for Home Health Agencies

As the most recent storm on its way past the East Coast leaves the United States mainland, it serves as a reminder of the hurricanes that hit the Gulf Coast region in recent years.

CradleMRx clients can rest assured, as they always have in hurricane evacuation situations that their patient records and workflow information are and will remain safe and available online anytime.

With hurricane season starting today (June 1st) and running through November 30, the obvious question remains:

Are you prepared for this hurricane season?

Please share with us any interesting anecdotes and/or useful tips for home health agencies as it relates to this topic.

Below you will find some useful links you may want to share with your colleagues and family members as well.

See the Tropical Cyclone Preparedness guide at from the U.S. National Hurricane Center.

Track storms from at the National Hurricane Center’s website.

Find Hurricane Information for Health Care Professionals at from the Center from Disease Control and Prevention CDC.

National Nurses Week – May 6-12

National Nurses week is celebrated annually starting on May 6th, which is also known as Nurses Day, and continues all week through May 12th this year. In honor of all nurses, everyone at Cradle salutes you for the daily caring gestures and positive impact you bring to the world daily.

The Department of Health and Human Services Secretary Kathleen Sebellius issued a statement which is worth reading for its insightful information about the impact of the Affordable Care Act has on the nursing world.

To read the full article, click here.

Texas and Florida Rank on Top in Medicare Home Health Utilization Report

Based on The Remington Report, which shows state-by-state data on reimbursements, patient count, patient visits, as well as their averages, Texas ranks highest in reimbursements followed by Florida.

The national average:

  • Total Reimbursement: $19,533,203,558
  • Patients: 3,452,459
  • Visits: 124,698,461
  • Average Reimbursement Per Patient: $5,691
  • Average Visits Per Patient: 36

On a comparison of the top two states with regards to Total Reimbursement, namely Texas and Florida:

  • Total Reimbursement:  Texas (1st) at $3,074,853,160 followed by Florida at $2,278,311,770
  • Patients: Texas (1st) at 368,722 followed by Florida (2nd) at 356,502
  • Visits: Texas (1st) at 22,074,537 followed by Florida at 16,877,067 (2nd)
  • Average Reimbursement Per Patient: Texas (1st) at $8,339 whereas Florida (6th) at $6,391
  • Average Visits Per Patient: Texas (2nd behind Oklahoma) at 60 whereas Florida is 5th at 47

To view the full report, click here..

CMS is Converting – OASIS Submission Changes

With CMS converting from AT&T to Verizon, how you submit your OASIS data to the state will also change. This new change affects only how you send OASIS data; it does not affect when you send (30 days from M0090 rule) OASIS data.

For more information direct from CMS click on the following CMSNet Information links:

CMS Posts List of Providers Sent Revalidation Letters

Due to recent requests by providers, CMS has released the first list of providers that were sent revalidation letters (Phase 1). If you enrolled prior to March 25, 2011 you may have received a letter. Letters will continue to go out up to March 23, 2015. For more information on the revalidation of Medicare provider enrollment, check out MLN Article 1126: Further Details on Revalidation of Provider Enrollment Information.

A sample letter as well as the Revalidation Phase 1 Listing can both be found in the Medicare Provider Supplier Revalidation Page.

If you are on the list but have not received the revalidation letter, please contact your MAC directly. Their numbers can be found at the Medicare Fee-for-Service Provider Enrollment Contact List.

Medicare Policy Updates: Partial Episode Payments

Patients must be informed of transfer procedures.

The Centers for Medicare and Medicaid services recently released updates to some provisions within the Medicare Final Rule. These adjustments make minor changes to some of the payment policies regarding Home Health episodes and patient transfers.

This information was released February 16th of this year, to be effective January 1st and implemented March 1st.

An intervening event (as defined by Medicare) occurs when a patient either:

  1. reaches their treatment goals or
  2. transfers to different Home Health agency before the end of the 60-day episode, then returns to the original agency for treatment.

When this situation occurs, several factors can influence which provider will receive payment, and for how much. If a patient has returned for treatment after reaching their goals or transferring, a new 60-day episode begins and a new plan of care and certification are required. Medicare payment for the previous episode is adjusted based on the amount of time the patient was under the agency’s care. This adjustment is the Partial Episode Payment (PEP).

However, if a patient has transferred because of a Skilled Nursing or rehabilitation admission, and returns to the initial agency for treatment within the same 60-day period, Medicare considers this a single episode covering the time from initial certification, including admissions, and the PEP would not apply. Rules regarding transfers between agencies have also been modified to adhere to certain new patient rights requirements. If a Medicare beneficiary elects to transfer to another agency, the receiving agency must document that they have informed the patient that the original agency will no longer receive payment for services rendered after the transfer date.

The new home health agency must also inquire as to whether the patient is currently under an established plan of care, by accessing the Regional Home Health Intermediary system. If so, the receiving agency is required to document that they have contacted the original agency and provided notification of the transfer. If this documentation can be provided by the receiving Home Health agency, the initial agency will not be eligible to receive the PEP or reimbursement for any overlapping care.

If the receiving agency cannot provide this documentation, their final claim will be canceled by Medicare and the original provider of service will receive full payment for the episode. Any disputes occurring between agencies regarding this policy are to be resolved through the Regional Home Health Intermediaries.

Texas Senate Bill 222

Texas flag

Update (5/19/2011): The CBA provision was recently removed from this bill. Thanks to the patients and providers that showed their support through contacting their representatives.

As a home healthcare provider, you may already know that the state legislature is considering several budget cuts this session. Among them is a provision to modify the statute regarding community-based alternative (CBA) programs under the Home and Community Based Care Service waiver, a state-administered service that provides medical and attendant care to consumers.

A community-based alternative program is one designed to provide in-home care to patients at risk of being placed in a nursing home. Services provided include medical, respite, and attendant care. A CBA differs from a Primary Home Care (PHC) program in that the PHC provides in-home assistance with activities of daily living and personal care but does not administer medical care.

Under the new guidelines presented in Section 1 of Texas Senate Bill 222, authored by Senator Jane Nelson (R-Flower Mound), a patient meeting the requirements for receiving attendant services under the community based alternative program must first receive their benefits through a Medicaid program such as Community Attendant Services and Primary Home Care services. The patient would only be eligible to participate in the CBA if the care required is care beyond what the Medicaid program can provide, or the services are altogether unavailable through any Medicaid program.

This new requirement would greatly impact home care services. Our company agrees with others in the industry that argue that it will further deplete an already underfunded program along with increasing cost to consumers and reducing employee pay.  This provision also creates a concern regarding quality of patient care.

In addition to providing solid software solutions, our company is committed to helping you make sense of relevant home healthcare news. Please check our blog frequently for updates on this issue.

Further reading:

Event Recap: Southwest Regional Home Care Conference

Last week, CradleMrx sponsored the Southwest Regional Conference hosted by the Texas Association for Home Care & Hospice. Our showing at the exhibition was a phenomenal success!  With large and small agencies in attendance from four different states, we had an excellent turnout of both current and prospective customers.

Booth preparations

Members of our staff prepare for the show

After a series of presentations discussing topics such as nursing efficiency, Medicare billing and reimbursement, and implementation of the Affordable Care Act, the exhibition hall opened with excitement and a full crowd at four p.m. on Tuesday.

More preparations

Our staff prepares to open the booth to attendees

CradleMRx was a gold sponsor at the exhibit, which was held in the Landmark Ballroom of the Hyatt Regency Dallas. The CradleMRx booth included a large video display of our software’s features as well as two separate product demonstration centers. Our staff was available to answer questions about the application and provide a hands-on example of the solution our company offers to the home health industry.

ICD-10 session introduction

CradleMRx Marketing Manager, Juan Patarroyo, introducing the ICD-10 speaker

The agenda for the second day included issues relating to patient advocacy, employment law, and ICD-10 implementation.  As a sponsor of the event, Juan Patarroyo, a member of the CradleMRx team, introduced the speaker for the ICD-10 segment.  We had outstanding exhibit attendance on Wednesday as well, with a large number of entries submitted for our Toshiba Laptop Giveaway.  Congratulations to our lucky winner!

Winner of our laptop giveaway

UX Manager Michael Hoskins presenting a brand new laptop to our lucky drawing winner

We would like extend thanks to all of our existing clients who came to visit us at the Exhibit Hall and a warm hello to everyone that stopped by for a demonstration of our software.  We look forward to working with you in the future.

Some of our staff

Left to right: Michael Hoskins, UX Manager; Juan Patarroyo, Marketing Manager;
Wale Balogun, VP Operations; Patrick; Frank Wisniewski, CTO

For additional information about our product, please visit  If you would like to view a calendar of upcoming TAHCH events, this can be found at

Upcoming Event: Southwest Regional Conference

This year’s Southwest Regional Home Care Conference & Exhibition will offer service providers an excellent opportunity to gain insight into new industry information, advances, and business solutions. The Texas Association for Home Care and Hospice is hosting this two-day exhibition for personnel across four states, making it an ideal chance to network with other agencies, educators, and vendors.

We recognize that the home care industry is an ever-changing field of new regulations and technology and strongly encourage our clients to attend this event. The Conference will be held from April 19th through the 20th, at the Reunion Hotel of the Hyatt Regency Dallas. A variety of speakers will be present at this event, discussing topics ranging from ICD-10 implementation, to patient advocacy, to the newest adjustments in Medicare reimbursement. A representative from our company will be personally introducing the speaker for the session entitled, “ICD-10 – It’s Never Too Soon.”

We will be showcasing the CradleMRx software at this event as well. Current and prospective agencies will be able to view and interact with a fully functional demonstration of our product and its features, while our representatives will be available to answer any questions you may have about the solutions our company offers.

For more information regarding this event, and to register, please visit the TAHCH website at For additional information about our product, please visit

Medicare Policy Updates: Face to Face Encounters

Medicare face-to-face encounters

Agencies should be aware of new face-to-face encounter guidelines

The Center for Medicare and Medicaid services recently released updates to some of the provisions issued by the Affordable Care Act. This additional information pertains mainly to the new face-to-face encounter requirement. It was issued February 16th of this year, to be effective January 1st, and implemented March 10th.

At the start of a patient’s home health care, the physician that certifies the plan of care must examine the patient face-to-face and provide adequate documentation to support that the encounter occurred. Certain allowed non-physician practitioners are also permitted to complete the face-to-face visit with the patient. These providers include state licensed nurse practitioners, clinical nurse specialists working with the certifying doctor, state approved nurse midwives, and physicians’ assistants under the supervision of the physician endorsing the plan of care.

The face-to-face requirement must be completed within 30 days after the start of care, or within 90 days before. Within the home health agency’s documentation, evidence of the face-to-face encounter must be included with submission of the certification. The agency’s record of the visit must include the service date and a short statement about why the patient’s observed medical condition requires medically necessary home care. It can be written, dictated, or generated from an electronic health record.

In certain situations, other providers may complete the face-to-face encounter and initial certification that home health care is needed. These include attending physicians in an acute care setting that examine the patient, verify the plan of care needed, and arrange for the patient’s transfer to a local agency.

Medicare also allows the face-to-face examination to be completed via a telehealth system. The encounter must originate at one of the following approved locations:

  • Physicians’ offices
  • Hospitals & Critical Access Hospitals
  • Rural Health Centers
  • Federally Qualified Health Centers
  • Hospital-based Renal Dialysis Centers
  • Skilled Nursing Facilities
  • Community Mental Health Centers

Unless the patient has transferred to another home health agency or been discharged and returns to the same agency for care, a re-certification and new plan of care are required for every 60-day episode.