Homebound Status—one of the five eligibility requirements for home care—Is being scrutinized by the Centers for Medicare and Medicaid Services (CMS) as well as many other insurance companies, like Blue Care Network and Blue Cross Blue Shield.
Even though many patients meet homebound requirements, some do not have documentation that supports it, which results in a missing piece of eligibility and will possibly cause recoupment issues. Although it is the responsibility of the patient’s provider to state the patient’s homebound status, it falls on each home care agency to ensure that every patient has an appropriate homebound status documented before billing.
It is also the responsibility of the home care agency to ensure that if at any time during the episode of the care, the patient is no longer homebound, the patient is discharged from services under that insurance benefit.
Since documentation of homebound status is being scrutinized so heavily, FocusChart has focused on providing prompts for complete documentation to support the patient’s status. Every comprehensive assessment includes an in-depth assessment of the patient’s homebound status that meets each required criterion.
The template that FocusChart utilizes is the homebound status portion of a document recommended by CMS in February 2018 to meet the requirements for Face to Face documentation. While homebound status is just a factor of the face to face, it is crucial. Often the face to face physician has not documented it clearly and completely on the encounter note.
There are many scenarios when agencies will not be able to obtain proper documentation of homebound status from the physician, and this portion of the comprehensive assessment can be substantiated by the physician and added to the patient’s record to meet the requirement. This has become an acceptable practice, with the proper documentation, by all MACs.
FocusChart has the capability of generating an “attestation” document to ensure that the agency has all documentation that is needed and the physician and agency work together to meet the needs of the patient.
Structural and functional components are incorporated into the homebound status on comprehensive assessments. During pre-claim review, MACs were auditing for specific structural and functional impairments that support homebound status and this is still highly recommended by CMS according to the suggested template provided by CMS. It is based on body system.
For example, if the patient had a spinal cord injury, they would have a structural impairment that causes decreased mobility and independence. An example of a functional impairment would be a cardiovascular illness such as coronary artery disease. FocusChart allows each user to use clinician documentation to substantiate homebound findings with the physician.
It is not a requirement for payment to have homebound status documented on every visit note. However, it is a requirement that the documentation of every visit note stands alone and supports the reason for homebound status of the patient. Well known industry experts suggest having some form of consistent documentation of homebound during each skilled visit. Thus, it has become common practice to have each skilled clinician document on the patient’s homebound status each visit.
FocusChart has developed a shortened version of the homebound questions, which can be elaborated on according to agency policy. This ensures that it is documented that each clinician assessed for homebound status each visit. It is the clinician and agency’s responsibility to ensure that the assessment documented reflects the homebound status of the patient.
4 Tips for Homebound Status Documentation
Be Succinct and Precise
Train clinicians that the answers to homebound questions should be succinct and precise. Long sentences, rambling words, duplicative sentences and other excessive documentation is not beneficial.
Focus on the Current Visit
The documentation of homebound status should reflect what is seen by that clinician, that visit. Focus on substantiating the homebound reason each visit, not reflecting the previous visit’s homebound status or even trying to match another discipline’s homebound status.
Document Measurable Data
Measurable data is important to state if it is known. If during a physical therapy session, the therapist notes that the patient could stand for only 30 seconds before feeling like they wanted to sit down, that should be documented. If the only reason the patient cannot leave the home is because they have 5 steps leaving the home and they cannot safely navigate steps because they have to use a walker, then document that as the reason.
Tell A Story
Remember, the chart should tell a story. If the patient gets exhausted every time they leave the home and they are unsafe and at risk of falling, tell that story! The only information auditors have about the patient is what they read in the chart.
Example of Homebound Status and Good Documentation
Martha, an 88-year-old widow lives alone in an independent living community. Martha has had many health difficulties over the last six months including two hospital stays for CHF exacerbation and new diagnosis of SVT. Both hospital stays were followed by two weeks in a rehab facility.
Martha feels deconditioned. She says, “when I stand to brush my teeth, I just feel like I don’t trust my legs. I have to turn my walker around and sit on it”.
Martha has been joining in events at the facility because she says if she sits in her room all day, she gets very depressed. Martha went to the grocery store last week on her facility bus. She explained that once she got to the store she didn’t have energy to walk around so she sat on a bench in the store the majority of the time. When she got home, she fell asleep on the couch unexpectedly and was surprised to sleep for 3 hours!
Document Martha’s homebound status
*Note: only the words in [brackets] would be clinician added text in FocusChart.
The beneficiary, due to illness or injury, needs:
- Supportive devices: [walker]
- Special transportation: [facility bus]
- Assistance to leave residence: [facility driver assistance]
There is a normal inability for the beneficiary to leave home [patient can only stand for approximately 2 minutes until she feels as though her legs won’t hold her up anymore, at risk for falling]
Leaving home requires a considerable and taxing effort [patient must take frequent rest breaks and reports exhaustion and the need for a nap when she returns from being away from home]