The agency that establishes the episode is the only entity (other than a doctor) that can bill and receive payment for medical supplies during an episode. In the case of quality measures based on data collected from the OASIS Home Health Quality Notification Program (HHQRP), a quality episode is a component of developing a measure of quality of home health. Quality episodes are used both in process measures (the effectiveness with which home health care agencies use specific evidence-based care processes) and in outcome measures (the outcomes of healthcare experienced by patients). Home health measures not included in the HH QRP Measures on potentially avoidable events (PAE) are a subset of outcome measures that are derived from OASIS data, but do not form part of HH's QRP.
The PAE measures were developed as part of the results-based quality improvement (OBQI) initiative that preceded the HH QRP. PAE measurements don't appear in Care Compare, but are available to HHAs through IQIES reports. Potentially avoidable events serve as markers of potential health care problems due to their negative nature and relatively low frequency. Reported potentially avoidable events are outcome measures, in the sense that they represent a change in health status between the start or resumption of care and discharge or transfer to an inpatient center.
For a list of health measures that could be avoided, see the home health PAE measurement chart, which can be found at the link to the home health measurement tables in the download section below. Technical documentation for calculating potentially avoidable health measures can be accessed through the link to the technical documentation for Oasis-based measures in the download section below. The download section also includes a link to the results-based quality control manual, which contains additional information on PAE measures. According to CMS, in PDGM, the first 30-day episode is anticipated.
All subsequent periods in the sequence are classified as late until there is an interval of at least 60 days between discharge and the start of care for the next episode. If 60 days have passed between episodes, the first 30 days of that onset of care are considered early and subsequent sequences and episodes are considered late. Keep in mind that this is automatically corrected in the claim, so agencies can't change late to early for an additional refund. Federal guidelines require electronic visitor verification (EVV) for home and community services (HCBS) that include an element of personal care services and home health services in state plans.
While these clinical groups represent the primary reason for using home health services for a 30-day care period, this does not mean that they represent the only reason for home health services. Health First Colorado also reimburses telehealth services to members who qualify for telehealth monitoring. For a list of home health outcome measures, see the table of home health outcome measures, which can be found at the link to the home health measurement tables in the download section below. Several factors contribute to the recent growing interest in understanding the role of home health care in the range of services for Medicare beneficiaries.
This measure evaluates the Medicare spending of a home health care agency, compared to the average Medicare spending of home health agencies nationwide during the same performance period. The provider should not include the dates of acute home health care or any lapse of care between the last date of the service provided by the previous home health agency and the receiving agency. Those admitted to a nursing home had a much higher level of services, in particular physical therapy and home health care services. While there are clinical groups where the primary motive for home health services is therapy (for example, musculoskeletal rehabilitation) and other clinical groups where the primary motive for home health services is nursing (for example, complex nursing interventions), home care remains a multidisciplinary benefit and payment is combined to cover all necessary home health services identified in the individualized home health care plan.
For each client admitted to the HHA care facility, HCFA forms 485 and 486 are completed to establish the home medical need and document treatment plans and other aspects of the case. Acute home care is defined as intermittent home health services that are provided up to 60 consecutive calendar days after the acute onset of an illness, injury or disability, hospitalization, or the acute onset of exacerbations that require specialized home health care, as described in the home health benefits coverage standard, mentioned in 10 C. All the code values contained in the NUBC UB-04 reference manual for each form locator cannot used to submit paper applications to Health First Colorado. All home health care services provided are subject to post-payment review to determine medical need and regulatory compliance. Oasis-based procedural measures are not risk-adjusted to show how often home health agencies provide the recommended care or treatments that research suggests provide the best outcomes for most patients.
These include measures related to all or most patients receiving home care, such as the timeliness of the start of home health care (SOC) or the resumption of care (ROC).
