January #HomeHealthChat: Home Health and Mental Illness

The January #HomeHealthChat was co-hosted by the Visiting Nurse Association of Ohio (@VNAOhio). Visiting Nurse Association of Ohio is a not-for-profit home healthcare and hospice organization.

The #HomeHealthChat focused on Home Health and Mental Illness.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

Opening the Front Door to Better Care

Published by Huffington Post
By Steve Landers MD,MPH
January 25, 2016

This article is co-authored with Dr. Bruce Leff, Professor of Medicine and Director of the Center for Transformative Geriatric Research at Johns Hopkins@HopkinsMedicine.

America is experiencing a dramatic population shift — one that will turn the country on its head. As Baby Boomers age, more people will live with chronic conditions, like heart disease or dementia, and many will have difficulty with basic abilities like walking and managing their household.

These shifts will create enormous challenges for our country. We must do everything possible to ensure that older Americans remain independent and healthy at home, without experiencing the suffering, indignity, and costs associated with unnecessary hospitalizations and institutionalization.

Our success in answering this call will dictate quality of life vs. suffering for millions of people. The country’s economic health is also at stake as the growing costs of Medicare and Medicaid threaten to squeeze out funding for other priorities. A key to solving this vexing problem is improving access to quality care at home.

In the wake of the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act of 2015, we are seeing a shift toward more care coordination and “value-based” care. These trends have led to more interest by doctors and hospitals in helping people succeed in home and community-based settings.

This new attention is a good start, but it’s not enough.

The focus of current reform efforts has centered on insurers, hospitals, physicians, and employers. Home-based care has been left out of high profile national policy conversations, despite the fact that most older Americans prefer to stay at home and “age in place.”

Our policymakers aren’t putting enough time and resources into strengthening home health care and developing new home-based care strategies. Further, some home care policy proposals actually risk hurting the positive programs that already exist.

Out of this leadership void, the Future of Home Health (FOHH) Project was born. Developed by the Alliance for Home Health Quality and Innovation , the FOHH Project has taken on the challenge of starting a national conversation on these issues and the project really picked up steam when the Institute of Medicine (IOM) and National Research Council (NRC) hosted ‘The Future of Home Health Care’ workshop. The summary book and videos from the workshop are available online.

A few overarching themes recurred throughout the workshop, these themes could provide a head start for leaders interested in improving care:

1. There’s no place like home. Stakeholders from many backgrounds called for a shift towards community based care–making the home the center of care whenever possible. Family caregivers at the workshop were especially passionate about the importance of home care.

2. Better care at lower costs. Home health care of the future must be a solution to high costs and quality of care concerns. One example is Medicare’sIndependence at Home Demonstration, which is showing that medical teams that make house calls to Medicare’s sickest and most costly patients at home can support these individuals and save lots of money.

3. Payment policy and regulations need improvement. To build and grow new approaches to home care there will need to be policy and payment changes that support innovation. Many current policies and programs are fragmented and outdated. There should be more coordination, integration, and alignment around addressing both medical and social issues. Several historical policies and programs have created an unnatural separation between medical and social concerns even though high quality care for an aging population requires both to work in concert.

4. Don’t forget about the workforce! We must improve training, especially in geriatrics and palliative care, for all types of health professionals. Developing people to work in team-based care will be key.

5. Technology, technology, technology. Smart use of mobile health, health information, remote monitoring, telemedicine, independent living, and point of care technologies are essential for the shift towards home and community based care.

6. Accurate report cards. Quality and outcomes will need to be measured in order to reflect the value of community and home-based care. We must take care to ensure appropriate quality measures that fit the needs and goals of older people with multiple medical problems, rather than current measures that often focus on single diseases.

The ultimate goal of the FOHH Project is to develop a framework for home health delivery in the future and to take advantage of the many promising innovations that have not been scaled widely due to gaps in policy and for lack of attention.

These efforts serve as a foundation for beginning a discussion, but more national dialogue is required, with input from a wide range of leaders. To truly have a person-centered, compassionate, and responsible healthcare system we must work on building a bright future and prominent role for home health care.

The Home Health and Hospice ICD-10 Transition Workgroup Closing the Coding Guidance Gap

October 1, 2015 came and went. The sky didn’t fall, but many agencies did stumble as they grappled with software glitches, struggled with insufficient documentation from referral partners and from their own clinicians, and as internal coding-knowledge gaps surfaced. Agencies also continue to receive conflicting and/or inapplicable guidance from the American Hospital Association’s (AHA) Coding Clinic, CMS’ designee for official ICD coding guidance and clarifications. These inconsistencies can lead to payment delays or claim denials.

Confusion over the use of ‘A’ as the seventh character indicating initial encounter by home health agencies brought the problem to light. In light of the issue, the Home Health and Hospice ICD-10 Transition Workgroup (the “ICD-10 Transition Workgroup”), of which the Alliance is a member, worked with CMS to ensure that the January 1, 2016 release of the home health Grouper reflected the AHA Coding Clinic’s guidance around use of the seventh character A. But this instance is by no means the only time when new guidance has caused confusion for the industry.

Numerous instances of guidance issued by the AHA Coding Clinic are not easily interpreted by or adapted to home health or hospice. The ICD-10 Transition Workgroup is working closely with the AHA Coding Clinic to address this concern. We have crafted a solution that we believe will ensure that guidance issued by the AHA Coding Clinic does not unintentionally lead to improper coding or create barriers to payment for home health or hospice.

Working on behalf of industry, the ICD-10 Transition Workgroup has developed an agreement with the AHA Coding Clinic. The AHA Coding Clinic has agreed to accept industry queries from the board of the Association of Home Care Coding & Compliance (AHCC) and the board of its credentialing body, the Board of Medical Specialty Coding & Compliance (BMSC), on behalf of the industry. As the BMSC board is comprised of eight of the nation’s leading home health and hospice coding experts, the AHA Coding Clinic has further agreed to accept with those queries a recommended response and the rationale for that response. The AHA Coding Clinic Editorial Advisory Board will consider the query as well as the recommended response before issuing guidance.

Coding questions should be submitted to AHCC using the following email: AHCCVoice@decisionhealth.com. BMSC board members will review the questions submitted to determine if there already is an answer to the question or if there is a need for clarification or additional guidance from the AHA Coding Clinic. If there is an answer, the board will point you to where that answer can be found. If the board believes guidance or clarification is needed, the query will be forwarded to the AHA Coding Clinic with the board members’ recommended response and rationale. Subsequent guidance issued by the Coding Clinic’s EAB will be distributed to the industry through a communique from your association.

By funneling all home health and hospice industry coding questions through one channel and disseminating resulting guidance or clarification throughout the industry at one time, we will be able to accomplish several significant goals:

  • Identify and resolve widespread coding issues affecting all agencies
  • Receive from the AHA Coding Clinic one response that applies to all agencies
  • Identify industry-wide knowledge gaps
  • Ensure correct and compliant coding based on first-hand knowledge of changing guidance

To our knowledge, the AHA Coding Clinic Editorial Advisory Board never has considered provider setting when issuing coding guidance. Now they will. This is an important step in ensuring that home health and hospice have the tools they need to correctly and compliantly code and submit claims.

About AHCC

AHCC is the community for professionals dedicated to providing quality care in post-acute care settings and establishing, meeting, and maintaining standards of excellence in their area of expertise.

AHCC’s credentialing arm, the Board of Medical Specialty Coding & Compliance (BMSC), offers professional credentials, including the only nationally accredited home health coding credential that tests coding skills exclusively, the Home Care Coding Specialist—Diagnosis (HCS-D), and the nationally accredited Home Care Clinical Specialist – OASIS (HCS-O).

BMSC has been credentialing home health coders since 2003. More than 63% of agencies require coders to have earned the HCS-D credential as a condition of employment. The credentials are overseen by an independent board of home health and OASIS experts nationally recognized as leading authorities. Each board member has more than 25 years of experience in home health and hospice, and all are in-demand home health and hospice coding educators.

*Home Health and Hospice ICD-10 Transition Workgroup

Alliance for Home Health Quality & Innovation

Teresa Lee, Executive Director


Association of Home Care Coding & Compliance

Corinne Kuypers-Denlinger, Executive Director; VP, Post-Acute Care Product Group, DecisionHealth

Tricia A. Twombly, CEO, BMCS; Senior Director, DecisionHealth


Centers for Medicare & Medicaid Services

Dr. William Rogers, ICD-10 Ombudsman


National Association for Home Care & Hospice

Mark K. Carr, VP, Regulatory Affairs

Theresa Forrester, VP, Hospice Policy & Programs


National Hospice & Palliative Care Organization

Jennifer Kennedy, Director, Regulatory & Compliance


Visiting Nurses Association of America

Liza Greenberg, VP, Quality (Interim)