This week's You Asked..We Answered questions ask: "A colleague recently shared that the Ohio Department of Health (ODH) has requested that nursing home transfer and discharge notices be sent via non-encrypted email. We are primarily concerned about HIPAA compliance. Could you please clarify this?" and "If a nurse practitioner (NP) works in the office with a physician and they are not the attending physician, does the attending need to sign off on the order the NP gives for hospice patients when they are acting on behalf of the attending? So, in other words, the NP is on call for the attending and the NP gives orders for the hospice patient, do both the attending and NP have to sign that order?" and "What are your thoughts on whether a patient needs a new face-to-face visit if they had a face-to-face visit less than 30 days ago for another admission? For example, a patient is admitted into their fourth benefit period and the face-to-face visit is completed. After two weeks, the patient revokes. The patient returns to the hospice one week later. Is a new face-to-face visit required?"
A colleague recently shared that the Ohio Department of Health (ODH) has requested that nursing home transfer and discharge notices be sent via non-encrypted email. We are primarily concerned about HIPAA compliance. Could you please clarify this?
The ODH Transfer and Discharge Department has stated that transfer and discharge notices should be sent through normal email delivery and not encrypted as the information being sent is not protected health information (PHI).
If a nurse practitioner (NP) works in the office with a physician and they are not the attending physician, does the attending need to sign off on the order the NP gives for hospice patients when they are acting on behalf of the attending? So, in other words, the NP is on call for the attending and the NP gives orders for the hospice patient, do both the attending and NP have to sign that order?
LeadingAge Ohio reached out to Palmetto GBA for their thoughts about the question posed. Palmetto stated that if an NP gives an order for a hospice patient on behalf of the attending physician (attending is not available) then the attending does NOT need to co-sign the NP’s order.
What are your thoughts on whether a patient needs a new face-to-face visit if they had a face-to-face visit less than 30 days ago for another admission? For example, a patient is admitted into their fourth benefit period and the face-to-face visit is completed. After two weeks, the patient revokes. The patient returns to the hospice one week later. Is a new face-to-face visit required?
LeadingAge Ohio reached out to Palmetto GBA to clarify if the face to face encounter from the previous certification period was sufficient for the individual when they are admitted into a new benefit period. Palmetto’s answer is as follows:
Although the date that the face-to-face (F2F) encounter is within 30 days of the readmission, based on the way I am reading the regulations, a new F2F encounter is required. The date that the patient revoked the Medicare hospice benefit, benefit period four ended, and all remaining days in the benefit period were forfeited. According to the regulations, when the patient is readmitted to the Medicare hospice benefit, a new benefit period begins (benefit period five in this case), which also requires the agency to fulfill all other admission requirements, which would include a F2F encounter. The regulations do not really address this specific scenario, but if you think about it, the F2F encounter performed prior to the start of the fourth benefit period was done to satisfy the requirements for recertification of the fourth benefit period, not a subsequent benefit period initiated by the patient’s revocation and readmission.
In addition, please reference the regulatory citations CMS IOM, Publication 100-02, Chapter 9, Sections 20.1, and 20.2.1 below:
20.1 - Timing and Content of Certification
(Rev. 188, Issued: 05-01-14; Effective: 08-04-14; Implementation: 08-04-14)
At the very end of this section, it states, “These requirements also apply to individuals who had been previously discharged during a benefit period and are being recertified for hospice care.”
20.2.1 - Hospice Election
For Medicare payment purposes, an election for Medicare hospice care must be made on or after the date that the hospice provider is Medicare-certified. As with any election, the hospice must fulfill all other admission requirements, such as certification or recertification, any required face-to-face encounters, or Conditions of Participation (CoP) assessments. See also Pub. 100-04, Medicare Claims Processing Manual, chapter 11, section 20.1.1.