02 — Capability · BC-1890
Post-Acute & Home-Based Care
Deliver and get paid for care after or instead of a hospital stay, at home or where the patient lives, across home health, skilled nursing and long-term care, hospice and home medical equipment; not clinical guidance. Hospital stays and discharge planning, inpatient rehabilitation facilities and long-term care hospitals are hospital services; non-medical personal care is not covered.
- Post-Acute Care
- Long-Term & Post-Acute Care
- LTPAC
- Continuing Care
In scope
- Home health intake, visits, point-of-care documentation and plan of care certification
- Skilled nursing and long-term care admissions, resident care planning and long-stay resident services
- Hospice election, interdisciplinary care, bereavement support and palliative care consults
- Standardized post-acute assessments, quality reporting, home medical equipment and setting-specific billing rules
Out of scope
- Hospital discharge planning and choosing the post-acute provider (see BC-1820.30)
- Claim transmission, remittance posting and denials common to every setting (see BC-1840.30)
- Longitudinal care management programs that follow patients across settings (see BC-1860.20)
- Inpatient and outpatient therapy services run by the hospital (see BC-1830.60)
Realized by · 0
- No product in the catalog yet.
Used in · 7
- Intake-to-Discharge · 01 Take Referral via BC-1890.10
- Intake-to-Discharge · 02 Authorize & Admit via BC-1890.10
- Intake-to-Discharge · 03 Assess via BC-1890.40
- Intake-to-Discharge · 04 Plan & Equip via BC-1890.10
- Intake-to-Discharge · 05 Deliver Care via BC-1890.10
- Intake-to-Discharge · 06 Bill via BC-1890.60
- Intake-to-Discharge · 07 Discharge & Report via BC-1890.10
Build it · 0
- Nothing in the library points here yet.
Decomposes into · 6
- BC-1890.10Home Health ServicesAdmit eligible patients to skilled care at home promptly, get the right clinician to each visit and record what was done there, and keep orders and certifications current for every period of care. The standardized assessment and period billing are separate capabilities.
- BC-1890.20Skilled Nursing & Long-Term CareAdmit residents at the level of care they need, plan and deliver that care in the facility, and support long-stay residents and their families, including the path to Medicaid coverage of the stay. The standardized resident assessment and stay billing are separate capabilities.
- BC-1890.30Hospice & Palliative CareAdmit patients who choose hospice with a valid election and certification, care for them and their families through an interdisciplinary team around the clock, support the family after the death, and offer palliative consults to seriously ill patients who are not in hospice. Hospice billing notices and the cap are reimbursement.
- BC-1890.40Post-Acute Assessment & Quality ReportingComplete the home health, skilled nursing and hospice standardized assessments accurately and on schedule, submit them on time, and track the quality measures, value-based results and public ratings that follow from it. Hospital quality measures and accreditation surveys are quality and patient safety.
- BC-1890.50Home Medical EquipmentGet the equipment and supplies a patient needs at home delivered, set up and kept working, with the orders and medical necessity records that let each item be paid and defended in an audit. Repairing equipment is asset maintenance and stocking it is warehousing.
- BC-1890.60Post-Acute ReimbursementBill each post-acute setting under its own payment rules, so home health periods, skilled nursing stays, hospice benefit days and equipment rentals are paid correctly the first time. Claim transmission, remittance and denials common to every setting are the revenue cycle's.