More than Half!

More than half of the dollar amount of claims reviewed by one intermediary were denied in the last quarter of 2014. Multiple results were published this past week. Most were for smaller amounts but the denial rates were similar. The results posted below are the results for an edit of claims with a HIPPS code of 1BGP*. These are patients who were in an early episode, a clinical severity of 2 and a functional level of two, and a service level of 5. This represents a very high paying patient who is receiving therapy but otherwise isn’t all that sick.

Over half of the dollars that were billed for these claims were taken back or not paid because of a focused medical review.

For now, this is where we stand. As unfair as it may seem, there is no other option than to address these numbers until your claims make their way through the appeals process. Please do not think you are being told to grin and bear it because we are angry, too.

Region Midwest Southeast
Total dollars reviewed 6,074,393.71 5,588,813.76
Total Dollars denied 3,498,994.66 3,285,618.64
Denial Rate 57.6 58.8

The good news is that most of the claims were denied for Face-to-Face encounter documentation and we can obviously expect fewer denials in the future but not for several months. The claims that will be scrutinized for the next several months will all have required Face-to-Face documentation.

The bad news is that many of these claims were denied for multiple reasons. For instance, in the Southeast Region, there were a total of 1817 claims reviewed producing 1562 denials. There were 865 claims that were denied because ‘MR HIPPS Code Change  – Documentation Contradicts OASIS MO Item(s)’ Look for this denial related to diagnosis coding and therapy. The functional and clinical domain (except for diagnosis) can change but the diagnosis coding should be fairly static throughout an episode unless there has been change.

What can you do?

Agencies need to fight fire with fire. If it’s details they want, give them every detail you have. Deprive them of the opportunity to take your money back.

  1. Admit all patients with a goal of one episode at most. Any further episode must be approved by someone who has reviewed the chart.
  2. Involve the entire staff in educating each other about documentation.
  3. Constantly remind nurses who already document well that the increased focus is not about them but getting paid.
  4. Documentation takes time and should be included as part of the visit rate. If nurses are running the roads all day and producing sloppy documentation at night when they are tired, visits need to be backed down until all work can get done.

The best solutions will come from within your agency. Take advantage of each individuals talents and get everyone involved. Post excellent notes where everyone can see them.

If you think you cannot afford this level of attention to detail, you might rethink that position if you are hit with an edit.

We can help prevent that with our fabulous coders who will ensure proper coding so the careplan can be written within a couple of days and followed to a T.   Call us or connect by email.



Home Health Conditions for Payment

We have looked and have been unable to find specific guidance on the new CoPs.  There was a phone conference scheduled with NGS that was cancelled and nothing so far from Palmetto GBA.  Help us out if you know anything.

Meanwhile, some people who are very knowledgeable and well respected in the industry differ from us in how we interpret what ‘estimating how much longer the patient will be on service at the time of recertification’ means.  Look for it below in larger bold text.

§424.22   Requirements for home health services.

Medicare Part A or Part B pays for home health services only if a physician certifies and recertifies the content specified in paragraphs (a)(1) and (b)(2) of this section, as appropriate.

(a) Certification—(1) Content of certification. As a condition for payment of home health services under Medicare Part A or Medicare Part B, a physician must certify the patient’s eligibility for the home health benefit, as outlined in sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act, as follows in paragraphs (a)(1)(i) through (v) of this section. The patient’s medical record, as specified in paragraph (c) of this section, must support the certification of eligibility as outlined in paragraph (a)(1)(i) through (v) of this section.

(i) The individual needs or needed intermittent skilled nursing care, or physical therapy or speech-language pathology services as defined in §409.42(c) of this chapter. If a patient’s underlying condition or complication requires a registered nurse to ensure that essential non-skilled care is achieving its purpose, and necessitates a registered nurse be involved in the development, management, and evaluation of a patient’s care plan, the physician will include a brief narrative describing the clinical justification of this need. If the narrative is part of the certification form, then the narrative must be located immediately prior to the physician’s signature. If the narrative exists as an addendum to the certification form, in addition to the physician’s signature on the certification form, the physician must sign immediately following the narrative in the addendum.

(ii) Home health services are or were required because the individual is or was confined to the home, as defined in sections 1835(a) and 1814(a) of the Act, except when receiving outpatient services.

(iii) A plan for furnishing the services has been established and will be or was periodically reviewed by a physician who is a doctor of medicine, osteopathy, or podiatric medicine, and who is not precluded from performing this function under paragraph (d) of this section. (A doctor of podiatric medicine may perform only plan of treatment functions that are consistent with the functions he or she is authorized to perform under State law.)

(iv) The services will be or were furnished while the individual was under the care of a physician who is a doctor of medicine, osteopathy, or podiatric medicine.

(v) A face-to-face patient encounter, which is related to the primary reason the patient requires home health services, occurred no more than 90 days prior to the home health start of care date or within 30 days of the start of the home health care and was performed by a physician or allowed non-physician practitioner as defined in paragraph (a)(1)(v)(A) of this section. The certifying physician must also document the date of the encounter as part of the certification.

(A) The face-to-face encounter must be performed by one of the following:

(1) The certifying physician himself or herself.

(2) A physician, with privileges, who cared for the patient in an acute or post-acute care facility from which the patient was directly admitted to home health.

(3) A nurse practitioner or a clinical nurse specialist (as those terms are defined in section 1861(aa)(5) of the Act) who is working in accordance with State law and in collaboration with the certifying physician or in collaboration with an acute or post-acute care physician with privileges who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health.

(4) A certified nurse midwife (as defined in section 1861(gg) of the Act) as authorized by State law, under the supervision of the certifying physician or under the supervision of an acute or post-acute care physician with privileges who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health.

(5) A physician assistant (as defined in section 1861(aa)(5) of the Act) under the supervision of the certifying physician or under the supervision of an acute or post-acute care physician with privileges who cared for the patient in the acute or post-acute care facility from which the patient was directly admitted to home health.

(B) The face-to-face patient encounter may occur through telehealth, in compliance with section 1834(m) of the Act and subject to the list of payable Medicare telehealth services established by the applicable physician fee schedule regulation.

(1) Timing and signature. The certification of need for home health services must be obtained at the time the plan of care is established or as soon thereafter as possible and must be signed and dated by the physician who establishes the plan.

(2) [Reserved]

(2) [Reserved]

(b) Recertification—(1) Timing and signature of recertification. Recertification is required at least every 60 days when there is a need for continuous home health care after an initial 60-day episode. Recertification should occur at the time the plan of care is reviewed, and must be signed and dated by the physician who reviews the plan of care. Recertification is required at least every 60 days unless there is a—

(i) Beneficiary elected transfer; or

(ii) Discharge with goals met and/or no expectation of a return to home health care.

(2) Content and basis of recertification. The recertification statement must indicate the continuing need for services and estimate how much longer the services will be required. Need for occupational therapy may be the basis for continuing services that were initiated because the individual needed skilled nursing care or physical therapy or speech therapy. If a patient’s underlying condition or complication requires a registered nurse to ensure that essential non-skilled care is achieving its purpose, and necessitates a registered nurse be involved in the development, management, and evaluation of a patient’s care plan, the physician will include a brief narrative describing the clinical justification of this need. If the narrative is part of the recertification form, then the narrative must be located immediately prior to the physician’s signature. If the narrative exists as an addendum to the recertification form, in addition to the physician’s signature on the recertification form, the physician must sign immediately following the narrative in the addendum.

(c) Determining patient eligibility for Medicare home health services. Documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) shall be used as the basis for certification of home health eligibility. This documentation shall be provided upon request to the home health agency, review entities, and/or CMS. Criteria for patient eligibility are described in paragraphs (a)(1) and (b) of this section. If the documentation used as the basis for the certification of eligibility is not sufficient to demonstrate that the patient is or was eligible to receive services under the Medicare home health benefit, payment will not be rendered for home health services provided.

(d) Limitation of the performance of physician certification and plan of care functions. The need for home health services to be provided by an HHA may not be certified or recertified, and a plan of care may not be established and reviewed, by any physician who has a financial relationship as defined in §411.354 of this chapter, with that HHA, unless the physician’s relationship meets one of the exceptions in section 1877 of the Act, which sets forth general exceptions to the referral prohibition related to both ownership/investment and compensation; exceptions to the referral prohibition related to ownership or investment interests; and exceptions to the referral prohibition related to compensation arrangements.

(1) If a physician has a financial relationship as defined in §411.354 of this chapter, with an HHA, the physician may not certify or recertify need for home health services provided by that HHA, establish or review a plan of treatment for such services, or conduct the face-to-face encounter required under sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act unless the financial relationship meets one of the exceptions set forth in §411.355 through §411.357 of this chapter.

(2) A Nonphysician practitioner may not perform the face-to-face encounter required under sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act if such encounter would be prohibited under paragraph (d)(1) if the nonphysician practitioner were a physician.

[53 FR 6638, Mar. 2, 1988; 53 FR 12945, Apr. 20, 1988; 56 FR 8845, Mar. 1, 1991, as amended at 65 FR 41211, July 3, 2000; 66 FR 962, Jan. 4, 2001; 70 FR 70334, Nov. 21, 2005; 72 FR 51098, Sept. 5, 2007; 74 FR 58133, Nov. 10, 2009; 75 FR 70463, Nov. 17, 2010; 76 FR 9503, Feb. 18, 2011; 76 FR 68606, Nov. 4, 2011; 77 FR 67163, Nov. 8, 2012; 79 FR 66116, Nov. 6, 2014]

5 Common (expensive) Errors

Sometimes we get discouraged because we seem to teach the same information over and over again. The fact is that many nurses in home health and hospice are new to the industry. Complicating matters is the fact that many of us have been around so long and are so familiar with OASIS and coding that certain that it is difficult to believe it is hard for the new kids on the block. If you are the new kid on the block, read carefully. If you aren’t the new kid on the block, read it and share. These five errors are common occurrences and there is no good reason for a good agency to leave this kind of money behind.

Low Vision:

It is easy to miss the mark here. We see low vision coded with no supporting code, supporting codes without a low vision code and no codes for vision even though the patient is on three drops for glaucoma. Consider that a patient with low vision is compromised. Even when low vision is not actively addressed in the care plan, the patient will be at higher risk for falls, require slower teaching because they may not be able to read your teaching guides and are prone to medication errors. Even when a diagnosis does not meet the criteria for low vision, be sure that the patient’s visual acuity, or lack thereof, is fully documented. Remember, low vision codes require a supporting diagnosis that is not corrected with lenses or surgery.

Omitted Diagnoses

The OASIS instructions for M1022 state that all diagnoses that affect the patient’s response or outcomes must be included in the secondary diagnosis list. Many clinicians are limiting their diagnoses to those that are actively being treated. Several denials have come across our desks where a reviewer actually includes the lack of orders and goals for a diagnosis as a reason for denial. Always refer to the OASIS Manual Chapter 3.

When determining which diagnoses should be included ask yourself if you think the treatment plan or the patient’s outcome would change if he or she did not have the diagnosis. Diabetes affects pretty much every system in the body and would always be included. GERD, maybe not so much. Low vision, Yes. Hypothyroidism, No. When the diagnosis really doesn’t affect the plan of care or the patient’s response to the plan of care, leave it off.

Too many diagnoses:

See above. There are some diagnoses for which an agency receives additional reimbursement that are put on care plans when they should not be. This puts the agency at high risk for denials. If a patient takes Nexium, it does not mean that they have GERD. If a patient is newly diagnosed and your care plan involves teaching diet and new meds, absolutely include it.

Symptom Codes

When a diagnosis is characterized by a symptom, don’t code the symptom. Arthritis is a condition that causes inflammation and pain of the joints. There is no reason to include pain. But, don’t forget to assess it, treat it and document pain in your notes of an arthritic patient.

Juggling Codes

A long time ago, someone told agencies that one reason they were being scrutinized is because the diagnosis codes never changed. That much is true. However, simply juggling the codes without any supporting documentation looks as though you rearranged codes to avoid having your patient look as though they were stable with no ongoing needs. If your patient doesn’t need you, discharge them. If your agency doesn’t like it, so be it. Move on. Do not be part of a culture that plays fast and loose with Medicare regulations.

Be sure to get with us if you have any questions or if you need any help with coding. We love questions.



Late to the Game

While we were attention to other things, the rules of the hospitalization game changed just slightly. Although penalizing hospitals for readmissions in not new, hospitals are finally paying attention when hit with their third year of fines and the potential for even greater fines in 2015.

Currently, the penalties are for Congestive Heart Failure and pneumonia. More measures have been added and the total penalty for re-hospitalizations next year will max out at 3 percent. That may not sound like a lot but consider that the median operating margin for hospitals with 200 beds was -7% and the average is increased by a few hospitals making an obscene profit. The ‘operating margin’ is the profit when only the payment and services are calculated. Other sources of income such as gifts, grants and investments are excluded. If a hospital that was average was to be hit with even a 0.5% penalty, it could be deadly. Furthermore, less than 1000 of the almost 5000 hospitals were not fined for 2013. If you are curious about the hospitals in your town, click here and look for the scrolling table in the middle of the page.

I know that numbers are boring. I appreciate that you suffered through this much of tonight’s post and hopefully you now have an idea of how your hospitalization rate has become less important than numbers you do not have. So, before you plan to attack the diagnoses that are troublesome to your referral sources, you should do just a little more math and find out your hospitalization rate for the following diagnoses.

  • Congestive Heart Failure
  • Pneumonia
  • COPD
  • MI
  • Elective Hip and Knee replacements (are they ever emergent?)

This should be easy but every coder sees the problem. Home Health agencies do not admit patients for pneumonia, MI or hip and knee replacements. There is no report that can be easily run. And yet these numbers are critical to your ability to demonstrate value to your best referral sources.

There are any number of ways this can be done. My preference is an old fashioned Excel spreadsheet. Another option would be for coders to add a suffix to Medical record numbers for each of the diagnosis categories to make it easy to run reports. Some computer systems have attributes that can be added. If your system allows it, you can query all OASIS data for the diagnoses the patient had treated in the hospital. Any or all of these options should be considered and at least one should be implemented.

After you have decided how to identify patients within the criteria, the next step is to regularly calculate the 30 day hospitalization rate for each subset of patients. Home Health hospitalization rates are calculated at 60 day intervals and the hospitals are interested in 30 days. Sadly, it is not enough to merely divide the 60 day number by two. I tried it. It does not work.  Patients go back to the hospital within 21 days for the most part.

Those of us who are mathematically challenged rely on simple rules. Count all the patients in a category and then count all of the ones who went to the hospital within 30 days (look for an OASIS transfer assessment). Then divide the big number into the little number. Example: 15 patients were admitted with Congestive Heart Failure. Two patients went to the hospital within thirty days of admission or Resumption. Divide the big number (15) into the small number (2). 2/15 = 13 percent.

For those of you who are not mathematically challenged, please rest assured that nobody is trying to insult you. This really is a big deal for some of us. If you are very gifted with calculating percentages, drop by the QA department and offer your services. Expect them all to say they know it already because many of us are embarrassed to admit we were daydreaming during 6th grade math. Still make a pretty graph or something for them. They will secretly love you.

After you establish the baseline, your agency can get an idea of how you are performing and what needs to happen to make your agency appealing to the referral sources. The answers are going to be different throughout communities and agencies but over the next few months, there will certainly be discussions on how to address each diagnosis code. In all instances, it will require constant monitoring. That much I promise.

Hopefully, once you get those numbers, you can next start planning to reduce them. We will be here doing as much as we can to help you. If you have any insight, please share it with us so we can enlighten the world.

Quarantining Kaci Hickox

When I went to nursing school, it was called isolation.  When HIV became better known, ‘universal’ precautions were implemented.  Every patient was treated as though they were HIV positive and they still are.  Now, there’s that pesky little Ebola bug and it is causing nothing if not widespread fear and panic.  It’s not blood borne and at this juncture, isolation precautions are being threatened. 

Unlike HIV, Hepatitis and other blood borne diseases, nobody is able to state with complete certainty that there is no risk of exposure from casual contact with an Ebola infected patient.  The odds are clearly in favor of no infection but someone wins the lottery against staggering odds every week or so.  A very low risk is not the same as no risk.

We are Americans and we want absolutes; unwavering positions, assurances and guarantees.  We want answers before we ask the questions and we do not sit well with not knowing.

Lacking absolutes, we conjure up every possibility in the universe.  Fear sells.  Anxiety is contagious.  If you want to sell a newspaper, write about something frightening. 

On the other hand, if you are a politician seeking reelection, preventing widespread panic and fear is the way to go.  The end result is that Americans get mixed messages and trust is eroded.

Where we stand now is between the press and the politicians with two very different agendas and neither of them is completely trustworthy.  It is for this reason that it’s reasonable to ask those people who have been in contact with Ebola patients to lay low for a couple of weeks until the period of incubation has expired.  The risk may be very low (as per the politicians) but the consequences are dire (according to the press).  It is in that measurement between risk and consequence that decisions are being made. 

Kaci Hickox, a nurse, is bound and determined to convince us all that mandatory quarantine is barbaric and illegal.  She knows that if she goes out in public, the fears of the community will escalate but strangely that is exactly what she wants to do.  She is basing her position on science but science has not revealed all there is to know about Ebola as yet.  She is forgetting that science is only half of the ingredients of a good nurse – the other half being compassion.  Where is her compassion for those individuals, perhaps thousands, who will lose sleep if she breaks quarantine?  Where is her compassion for her neighbors who will voluntarily isolate themselves out of fear? 

I gather Kaci Hickox, who took care of Ebola patients for 4 weeks in Sierra Leone, is so utterly confident in her own isolation techniques that she believes it to be impossible that she is sick with Ebola.  I have seen that kind of confidence before and it never ends well.    

In comparison, Nina Pham and Amber Vinson took care of an Ebola patient in a US Intensive Care Unit – a far cry from the facilities available in West Africa.  Maybe Kaci Hickox is a much better nurse than the Dallas crew or maybe she is just selfish. 

Her lawyers are falling back on a supreme court opinion that says that quarantine cannot be enforced based on fear alone.   One look at the number of cases in West Africa and the trend would scare the Supreme Justices, too.  Just for fun, check out this graphic from the Economist.

I wish I had all the answers.  This much I know….  If I had been in Sierra Leone taking care of Ebola patients and then flew home to the US, I would be tired.  Jet lag is a killer all by itself.  If someone offered to bring me food and told me to hang out at my house for a couple of weeks, I could live with that.  I could appreciate that even though the risk of spreading the virus is very low, the risk of frightening my neighbors is very high and I do have compassion for most of my neighbors. 

Maybe Kaci Hickox is fearless and brave but a new mother who ran into Ms. Hickox at the mall with her infant child might very well live in frank, abject fear for weeks when she is already tired and cranky.  A corner grocery store where people shop might suffer enormously if Kaci Hickox showed up there. 

None of this matters to Kaci Hickox.  I am not used to nurses being selfish. She is like a three year old who wants to go out and play and doesn’t quite get that none of the other children want to play with her.  I understand that the fear is out of proportion to the risk but fear is as ruthless as Kaci Hickox appears to be. 

A greater concern is the fact that she is forcing the hand of authorities to use a higher level of vigilance than would be necessary if she took a break from the ‘all about me’ attitude.  She is taking the attention away from where it needs to be which is on the virus and it’s prevention and cure and bringing it to herself and her own desires to wander around aimlessly regardless of how uncomfortable her presence makes others feel. 

If any of you are brave enough to go to Sierra Leone, have no fear.  You will have our undying support.  Blog readers everywhere will make you wish you were isolated even longer so you could bask in our undying admiration for you.  But, please do not go if you are not prepared to lay low and err on the side of safety when you return if you err at all.  We don’t want to hear about your ‘rights’ when the consequences are so great even though the risk is small. 

When science tell us there is zero chance of spreading the disease, we will come and hug you but until the guarantee is in place and supported by evidence, we’ll worship from afar. 

Nina Pham


The CDC, among others, have suggested that perhaps more training is needed to ensure that direct health care workers are properly using protective equipment.   According to that line of thought, poor Nina Pham simply did not know what she was doing when she picked up a touch of Ebola from her patient.  If only she had more education on how to put on gloves and a gown, this whole disaster could have been avoided.

I think not.

I posted my dismay regarding re-educating nurses on FaceBook and was amazed at how smart my friends are.

One non-nurse, Michelle said that education was a way to protect the facility.  In other words, when a policy is violated, the hospital is able to assure any surveyor or lawyer that they did, indeed, provide the education and training and have therefore met their responsibility.  Sadly, a successful healthcare facility (and by successful, I mean isn’t closed down) must cover all bases to minimize damages.  I would probably waste time and resources re-teaching PPE, too if I had to make the decisions.

She also pointed out that maybe protocols are not strictly enforced when the risks are lower which could lead to bad habits.  I agree.  Ever notice how MRSA is already a problem when we start monitoring hand hygiene?  (I love that.  Hand hygiene – soon there will be an aisle in the supermarket for hand hygiene products instead of soap, antibacterial gel and hand lotion.)

Lisa Selman Holman pointed out how very miserable PPE is to wear.  She is right.  It is hot and sticky, nothing fits right and it is ugly in the most unforgiving way.  I have yet to figure out how looking like Big Bird assists in the infection control process. Healthcare workers, especially those with a fashion sense, can’t wait to take it off.

If ever there was a time to spend money, this would be it.  Athletic clothing manufacturers have done amazing things with sports gear.  It seems like a clothing manufacturer who exists because they make comfortable, functional clothes that can wick away perspiration, kill enough germs to smell good and keep a body warm in water might be able to help design something comfortable, disease proof, easily taken on and off  with the assistance of an infection control specialist.

Sara Kawaguchi came up with the idea of having two people involved – one present simply to observe.  I love this idea and it is cheap to do when considering the stakes.  Having never met Miss Pham, I can only assume that she didn’t tear a glove, look at it and say, ‘Oh darn,’ and carry on with restarting an infiltrated IV line.   If she breached protocol, it was likely unnoticed by her.

My cousin, Steve, is a physician and his response was simple.

1) we are human
2) we make mistakes
3 there is no room for a mistake here, in flight or in surgery

There’s a lot of truth in that but we can minimize mistakes.  Even the world famous Quality Assurance plan designed by Toyota, Six Sigma refers to only six errors in a million.  When it comes to Ebola, nobody wants to be one of the six.

The Checklist Manifesto by Atul Gawande is written by a surgeon who almost killed a patient because he forgot to do something very simple and standard prior to surgery – type and match blood.  After this near catastrophe that left his confidence shaken, he set about researching how to prevent errors.  It turned out that aviation history was marred by the crash of the first B17 in which several people died.  It almost took Boeing aircraft out of the game completely.  The solution included a checklist which enabled the (highly skilled and trained pilots) to fly 12 planes a total of 1.8M miles without incident.  It is now used universally.

Checklists are not designed to educate anyone.  If you have ever turned in visit notes only to find out that you forgot to write a narrative because you were interrupted, you are prone to human error.  If you have ever been called about a bill you know you paid only to find the stamped envelope in your purse, you could have used a checklist.  They are designed to let you pick up where you left off in the event something slips your mind, you are preoccupied or there is chaos all around you.  They ground and center the user.

There are undoubtedly numerous approaches to improving the safety of healthcare workers but re-educating the staff in a critical care unit on how to put on and take off PPE is an intervention for the hospital – not the nurses.  Don’t tell me that the staff in an intensive care unit requires more schoolin’ to put on gowns, masks and gloves.  Make them more comfortable so they aren’t urgently ripped off like they were on fire the minute you clear the room.  Have someone else watch.  Use a check list.  Doing more of what was done in the past because it didn’t work doesn’t quite make sense to me.

What the healthcare staff needs the most is a cure for Ebola.  When it comes to caring for a patient with Ebola, especially at the end of life, perhaps the most important changes will come about from the staff who were actually there doing the job.  If the blame game stops and the focus is directed to increased protection of healthcare workers, why not consult that handful of clinicians who are the only ones in the United States to have cared for Ebola patients in US hospitals?

I know that you join The Coders in wishing Godspeed to Nina Pham’s recovery.  She was able to be there for a patient isolated from his family and friends when he needed them the most.  People like Nina Pham do not put their own lives on the line for a paycheck.  She has a calling and I pray she will be back at work sooner than later.

Also,  let’s not forget that Nina Pham is not alone.  A few dozen other healthcare workers who took the same risk as Nina Pham and so far, have been free of symptoms.  These include the staff in Dallas as well as Nebraska and GA where two other Ebola patients have been treated.  They are no less heroic because they have not contracted Ebola; they just haven’t made the news and I hope they don’t any time soon.

Ebola? Here in the States?


It looks like we have company in the form of another virus.  Ebola has caused quite a stir in the US and the media is torn between reporting it as a benign little incident so insignificant as to not warrant our attention and predicting Armageddon.  With all new viral pathogens, it is difficult to predict.  A virus will do what it can to survive and most times that means reducing the severity of the illness so as not to kill its host and prolonging the incubation period.  Who knows what Ebola will do.

If 40,000 fatalities from Ebola were predicted this year, there would be mass panic.  If there was a preventative measure, who wouldn’t do what they could to get it  no matter what the cost? 

We are looking at close to 40,000 deaths from flu and pneumonia this year.  There are legitimate questions about these statistics such as why are flu and pneumonia lumped together as the 8th leading cause of death?  They are not the same disease.  To dispel the statistical arguments, lets pretend that only 20,000 deaths will result from the flu this year.  Tragically, most cases of the flu are preventable at no cost to most people.

Setting death aside for a minute (or hopefully many years), consider the experience of having the flu.  The first day or so, patients are afraid they are going to die.  As it reaches its peak, they are afraid they will not die.

We don’t want our patients to feel like that.   Many home health patients will end up in the hospital if they get the flu.  Hospice patients may be terminal but most have plans to die from something less miserable.  It is okay to get between the flu and your hospice patient. 

So, while we are panicking about Ebola, let’s keep in mind that there are thousands of lives we can save with a simple flu shot.  The CDC has a ton of free resources that you can use in your agency, patient homes, and community to promote vaccination.  Most have room for your company logo and the CDC is fine with you adding it.  Think about it.  When was the last time that the government provided you with professionally designed materials to be used in promoting your agency or hospice? 

When we figure out what we can do about Ebola, we’ll post it here.  Until then, get out there and stick as many old people with needles as you can.  Here are some codes you can include on your care plan if you know upon admission that you will be giving a flu vaccine.

  • V03.82 Vaccine for Streptococcus Pneumonia (PPV)
  • V04.81 Vaccine for Influenza Virus
  • V06.6 Streptococcus pneumoniae [pneumococcus] and influenza

Is anyone qualified to write or help us write a short blog on how to bill for the flu and pneumonia vaccines?  Let me know below or by emailing