hospice of dayton | presentation title here | 26 july 2011 | 1 miami valley long term care...

Hospice of Dayton | Presentation Title Here | 26 July 2011 | 1

Miami Valley Long Term Care Association2/21/2012


Committed to providing superior

care to our patients and families.

HOSPICE OF DAYTON IS COMMITTED TO

YOU…


In 2011, Hospice of Dayton provided:

239,269 days of care $435,903 in charitable care

ServingPatients


WHAT WE STAND FOR…

We are the only hospice in the Dayton area that has attained Deemed Status by the Joint Commission.


Hospice of Dayton was founded in 1978, preceding the Medicare Hospice benefit, as the city of Dayton’s first and only not-for-profit hospice and remains the area’s largest hospice care provider.


We have two Hospice Houses that allow 24 hour visitors, allowing families and loved ones to spend the night with no limits to children and pets


86% of our RNs are CHPN Certified

72% of our STNAs are CHPNA

Certified


We have 8 full-time Medical Directors who are certified in Hospice and Palliative

Care

http://rds.yahoo.com/_ylt=A0PDoS9x_PlO2DQAvfqjzbkF;_ylu=X3oDMTBpcGszamw0BHNlYwNmcC1pbWcEc2xrA2ltZw--/SIG=122f5f7hd/EXP=1325034737/**http:/fertilefuture.ca/medical-professionals/


As part of our commitment to patient care we have:

• 172 STNAs• 207 Nurses• 12 Chaplains• 25 Social Workers• 7 Massage Therapists• 2 Music Therapists• 2 Occupational Therapists• 1 full-time Pharmacist • 11 Nurse Practitioners


In 2011 our team members attended to more than 3,443 deaths, reaffirming our commitment that no one should die alone

http://rds.yahoo.com/_ylt=A0PDoX5vfh1PswgAv_ejzbkF;_ylu=X3oDMTBpcGszamw0BHNlYwNmcC1pbWcEc2xrA2ltZw--/SIG=12fonj95v/EXP=1327361775/**http:/www.gradydoctor.com/2010/11/terms-of-endearment.html


Since 2005, Hospice of Dayton’s grief counseling center Pathways of Hope has provided:• 19,621 one on one counseling sessions at no cost. Thirty percent were to community members

• 750 children with one on one art therapy

• 302 children have attended Camp Pathways

• Support groups helping 2,684 individuals. Forty percent of those individuals came from the community. Total of 1,334 group sessions

• 6,505 music therapy sessions solely to hospice patients

• Training workshops to the community on grief issues involving 4,973 community attendees


In 2011, our 630

volunteers contributed

61,000 hoursCamp Pathways

Flower arrangements

Goody bags

Stylist’s wigs


We have 677 full-time employees, with 106 having 10 or more years of experience with Hospice of Dayton, and we were recently ranked on Dayton Daily News' Dayton Metro Area Top Workplaces list for 2012


We’ve Expanded Partnerships

• We have palliative agreements with the following hospitals: Miami Valley, Kettering Health Care System

• We have contractual agreements with 108 Extended Care facilities

• We are in the midst of conducting patient-care research and providing massage therapists to Miami Valley Hospital, Dayton VA, and Children’s Medical Center


Hospice Room & Board BillingPresented by:

Teresa Carpenter, BSB, RHITCynthia Brown, Manager of Business

Administration


Bed Hold Days

5101:3-16.8 Ohio Medicaid Bed Hold Rules– ICF Bed-hold day, also referred to as ICF leave day means a day for

which a bed is reserved for an ICF resident through Medicaid payment while the resident is temporarily absent from the ICF for hospitalization, therapeutic leave days, or visitation with friends or relatives

– Payment for the ICF bed-hold days may be made only if the resident has the intent and ability to return to the same ICF. A resident of ICF bed-hold status is not considered discharged from the ICF since the facility is reimbursed to hold the bed while the resident is on temporary leave


Bed HoldExclusions Under Hospice Care

5101:3-3-16-8 I. 1. A person enrolled in a Medicare or Medicaid hospice program is not entitled to Medicaid covered ICF-MR bed-hold days. It is the hospice provider’s responsibility to contract with and pay the ICF-MR provider to cover the bed hold benefit

– Hospice of Dayton will pay 50% of the Medicaid Room and Board Rate per day, for up to 30 calendar days a year

– If admission to Hospice of Dayton is established while resident is in the hospital, from the date of admission to hospice services, bed hold will begin from admission date and paid until the patient returns to facility.

– DOD is not paid unless admission and DOD/Discharge occur on the same day


Respite Stays

• Respite/Caregiver Relief payment is based on each individual ECF contract

• Hospice of Dayton will pay for up to 5 consecutive days for each Respite stay at the rate as specified in the facility contract

• After the 5 days stay, families may choose to pay privately for the resident to stay longer at their own expense, and facility availability


Patient Liabilities

ODJFS does not provide Hospice of Dayton with 9401 forms or any forms regarding Patient Liabilities

– Inform our Medicaid biller as soon as you receive a new 9401 or PL from the

County and your billing will be corrected timely (we need copies of all 9401 forms to process the nursing home spans when issues arise)

– Notify us immediately of any corrections monthly on patient liability must be submitted to our Medicaid biller in order to receive payment/adjustment

– To receive payment from HOD, we must receive changes of liabilities to match Ohio Medicaid timely filing requirements of 180 days from original date of claim submission to Ohio Medicaid in order to bill and pay additional liabilities to your

facility (Refunds back to Ohio Medicaid can always be processed)

(If we can’t bill and be paid by Medicaid we can’t pay your facility but we can process refunds to the State of Ohio)


Medicare Cut Letters &

Discharge Days• Medicare Cut Letters are often signed when a patient discharges for improvement or curative

treatment from a hospice program and Medicare is the primary payer of Hospice

• These forms DO NOT have any bearing on a Medicaid recipient and their room & board benefit

• HOD will not pay the discharge day for room & board patients in accordance with Ohio Medicaid regulations unless the admission and discharge occur on the same day

– If any staff say “we will cover this day”, contact our billing department for clarification…because this form only applies to a patients Medicare benefit.

– The verbiage, “Last covered day, 05/13/11 will be covered until 11:59 pm” only applies to Medicare patients and their hospice benefit only

– Example: If 05/13/11 was the “discharge day” for hospice care for a resident, the last covered paid Room & Board covered day would be 05/12/11


ECF Internal Audits

• From time to time, ECFs will conduct internal audits of their receivables and find there are balances left from the past that are either debits or credits

– Please be mindful that HOD follows the same timely filing limits as Medicaid; should the audit show HOD owes an old or missed resident days

– HOD follows the same timely filing limits of 180 days for adjustments and 365 days from date of service to bill a new claim

– Also remember that we may be able to help you find or explain funds; contact our Medicaid biller to help review and explain audit issues you facility may be having

– We keep billing sheets for every facility and patient payment in our archives to help your facility with their audit process

– All credits will be taken back regardless of age and processed with Medicaid


Examples of Monthly Billing Sheets


Electronic Funds Transfer

The Hospice of Dayton has a policy to help make monthly funds exchange easier than ever

• If you still receive paper checks, by switching to an EFT, you can have your HOD payment to you on the 10th business day, dropped straight into your ECF bank account

• Our Medicaid biller will still provide the same service as before, offering billing sheets and adjustment corrections as necessary, without the inconvenience of waiting for a paper check

– Contact, Mindy, Cynthia, Teresa, or your Account Manager to learn more!


Ancillary Coverage

– All covered items must be related to the patients Primary Terminal Hospice Diagnosis and clinically necessary to receive reimbursement for HOD except for Incontinence supplies

– If you are unsure if an item is covered you can bill it anyway and our Accounts Payable Manager will let you know if we need to deny it or you can contact our staff for clarification


Examples of Ancillary Items

– Dietary Items We pay for tube feedings if it is their sole source of nutrition We DO NOT pay for Nutritional supplements

– Universal Precautions We DO NOT pay for universal precautions (gloves, gowns, masks, etc…)

– Personal Care Items We DO NOT pay for personal care items (toiletries, laundry, beauty, etc…)

– DME and Oxygen We allow contracted DME and Oxygen vendors to bill us directly. We will pay

comparable pricing to Therapy Support, Inc.

(if authorized and no contracts are in place)


Examples of Covered Items for all Hospice

Patients– Incontinence Items Diapers Chux/Under pads

– You can choose to bill these by line item or by per diem rate of $3.31 per day which includes all of the above in the daily rate

– No standard billing form is required, whatever process is the most convenient to send to our Accounts Payable Manager will be accepted (The monthly billing sheet is a great tool to determine patient days to apply a per diem rate)


QuestionsPlease do not hesitate to call us!

Medicaid Biller-Mindy Spencer’s direct line @ 937-258-4996 or email Mindy @ [email protected]

Manager of Accounts Receivables- Teresa Carpenter’s direct line @ 937-258-4994 or email Teresa @ [email protected]

Manager of Accounts Payables-Cynthia Brown 937-256-4490 @ extension 4426 or email Cynthia @ [email protected]

Prior Authorization Department- Judy Colby 937-256-4490 @ extension 4410 or email Judy @ [email protected]

Clinical Determination- Fred Craigette 937-256-4490 @ extension 2289 or email Fred @ [email protected]

Pharmacy Issues- Dana Bowling, team assistant 937-256-4490 @ extension 2257 or email Dana @ [email protected]

You are VERY important to us, and should any questions come up that you need answered, do not hesitate to call, we are here for you!

mailto:[email protected]







THANK YOU

hospice of dayton | presentation title here | 26 july 2011 | 1 miami valley long term care...

Documents

hospice patients

notforprofit hospice

dayton va

medicare hospice benefit

temporary leave slide

icf resident

resident of icf bed

hospice room board billing