Viewing posts categorised under: Coding

Prepping for PDGM

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Clinical Practices, Coding, Payment Rate Updates, PDGM

Prepping for PDGM

PPS final rule increases agencies' payments for 2019, finalizes PDGM

 
Now in the third week of January, 2019 and the PDGM model will be here in less than a year. Medicare-certified home care agencies need to begin NOW to prepare for the 2020 transition to a Patient-Driven Groupings Model. The proposed PDGM model, required by the Bipartisan Budget Act of 2018, is intended to remove current incentives to over-provide therapy services and changes the 60-day episode of care unit of payment to 30 days according to CMS. Also, a new set of groupings for the patient – diagnosis and functional levels – will be introduced that determines the patient’s reimbursement for the new 30-day episode. The PDGM model is planned for implementation on January 1, 2020 (Harris, 2018). Home care agencies should focus on several areas within their agency in order to prepare for PDGM. The fits area of concern should be the referral systems. According to Home Health Care News' Kaitlyn Mattson, "CMS’ move to shake up case mix specifically in regard to referral source is, at least in part, due to data and the agency’s belief that patients coming from institutional settings are typically sicker and, thus, need more care and resources." Moreover, "“60% of referrals come from the community,” Gina Mazza, director of the regulatory and compliance division at Fazzi Associates, told HHCN. “Every agency needs to understand how they specifically will be impacted by this new payment model. This is an area agencies really need to think about—what’s my patient population look like? Where do my referrals come from? Are there opportunities for me to make any changes?” Mazza added, “Referral source is always an area agencies want to work on, cultivate” (Mattson, 2018). Another area is staff education which is key to smoother PDGM transitions. Supporting on-the-ground staff may be the key to an easier PDGM transition. “Having the resources available to do the education—to stay on top of making sure nurses understand and are able to still spend the amount of time they want with their patients while fulfilling all the new requirements [will be paramount],” Susan Adams, vice president and administrator at Masonicare Home Health and Hospice (Mattson, 2018). Now finalized by CMS, there will be a learning curve with PDGM until staff becomes more comfortable with the intricacies of the rule. Agencies need to set aside a significant amount of time and attention so they can work with staff, so that assessments and documentations are really tight, Joy M. Cameron, vice president of policy and innovation at ElevatingHom said (Mattson, 2018). Confused? Frustrated? Not sure where to begin prepping for PDGM? Don't worry. SelectData has you covered. Contact our Business Development team to find out how SelectData can help you smoothly transition into PDGM today! Call 800-332-0555 or email info@selectdata.com and ask about our PDGM solution today! Resources Harris, T. (2018). OASIS-D GG0100B OASIS Home Health - Prior Mobility Functioning and Physical Therapy. Home Health Blogger. Retrieved from: http://go.myhomecarebiz.com/blog/oasis-d-gg0100b-prior-mobility-functioning-is-the-key-indicator-for-physical-therapy Mattson, K. (2018). PDGM Likely to Shake Up Patient Populations for Home Health Agencies. Home Health Care News. Retrieved from: https://homehealthcarenews.com/2018/08/pdgm-likely-to-shake-up-patient-populations-for-home-health-agencies/

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CoPs Breakdown on the New QAPI Regulations

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Clinical Documentation Improvement, Clinical Practices, Coding, Compliance, Conditions of Participation (CoPs)

CoPs Breakdown on the New QAPI Regulations

Adopt New Techniques

 
On January 13th, the rules for CoP's Quality Assessment and Performance Improvement regulations changed. Section 484.65 QAPI has replaced sections 484.16 (Group of Professional Personnel) and 484.52 (Evaluation of the agency’s program). The new section does a great deal to highlight the responsibilities of the agency's executive team and expects the governing bodies to focus on technology concepts like data- driven indicators to identify, track, and measure quality initiatives for high risk, high volume or safety issues. The program includes 5 standards: • Program Scope 484.65 (a) • Program Data 484.65 (b) • Program Activities 484.65 (c) • Performance Improvement Projects 484.65 (d) • Executive Responsibilities 484.65 (e) Program Scope Agencies are required to develop a data-driven QAPI program with measurable improvement indicators. The organization must measure, analyze, and track quality indicators including a patient’s adverse events, as well as other signs of performance to assess processes, services, and operations. However, it is not enough to just create the indicators. Agencies must use data to provide evidence that the improvement has led to improved health outcomes (ex: reduced hospitalizations, ED visits), safety and quality of care for patients. Program Data The QAPI program must utilize quality indicator data, including measures derived from OASIS that CMS has reported, to assess the quality of care provided to the patients and identify, prioritize, and manage opportunities for improvement. The QA efforts, including data collection, should focus on high-priority safety and health conditions. Like the program scope, data collected should support the quality measures and identify opportunities for improvement. Agencies will need to focus on those areas of past performance which have proven problematic for the agency over time or areas where there was clear evidence of poor patient outcomes as well as high risk and high volume. Program Activities The QAPI activities should include incidence, prevalence, and severity of problems in those areas. So that preventative actions and mechanisms can be implemented, agencies must track and analyze activities over time to ensure sustained improvements. Management should immediately correct any issues identified that directly or potentially threaten the health and safety of patients. Performance Improvement Projects The QAPI program requires that agencies performance improvement projects be conducted annually, at a minimum. The plan should reflect each agencies unique scope, complexity, and past performance. There should be clear documentation of the QAPI projects including the reason for conducting these projects and the measurable progress achieved. The agency’s governing body must define, implement, and maintain a program for quality improvement and patient safety that is ongoing and agency-wide. Executive Responsibilities The governing body for each agency is responsible for ensuring the QAPI reflects the complexity of the organization and its services, including contract and arrangement, are focused on indicators related to improved outcomes. They must also approve the frequency and level of detail in data collection. The governing body should establish clear expectations for patient safety and address issues in performance across the spectrum of care including the prevention and reduction of medical errors. For more information on this topic or on our Document review and Coding Services or Revenue Cycle Management, please call Select Data at 1.800.332.0555.
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians Click here to read more.

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Making the Most of Your Home Visits

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Clinical Documentation Improvement, Clinical Practices, Coding, Conditions of Participation (CoPs)

Making the Most of Your Home Visits

Advocate For Your Patients and Yourself

 
The Clinician's Role Home health patients are often referred from a facility. Therefore, transitioning from a well-equipped, well-staffed environment to receiving care at home can be a daunting task for the patient and his or her care givers. Home Health clinicians play a huge role in making this transition go smoother. It is imperative that clinicians are strong in their communication, education, assessment, and leadership skills. With experience, clinicians will develop a skillset that assists in completing a visit systematically. With ever increasing regulatory demands and a growing senior population, it’s easy, especially for less experienced clinicians, to become overwhelmed during the flurry of activity that can happen during a home visit. From time to time even veteran clinicians should reevaluate their routines to make sure they are delivering excellent care while being efficient and methodical. This article has some tips to help clinicians evaluate and improve their routines. Accurate Documentation Visits need to be completed in a timely manner and in accordance with CMS regulations. Be sure to follow MD specific orders for admissions and/or discharges. OASIS item M0102 and M0104 (MD ordered SOC & Date of Referral) are process measure items and impacts star ratings, therefore accuracy is very important. Make sure your great care is well represented with great documentation. Be organized and have structure for the patient’s assessment and care. Set an appointment with the patient for visits. Consider the patient’s preference regarding the visit time. Their input may assist in a more productive experience. Once an appointment is set, plan accordingly. Map out the driving route to the home and consider any potential weather impact or road construction to prevent unnecessary delays. Prepare for the visit by reviewing all paperwork, including the referral and physician documentation. Knowing about the patient’s recent procedures, medical and social history, and current living arrangement will be beneficial. These topics are often discussed in the physician’s History & Physical documentation. Keep supplies organized, readily available for care during the visit to prevent wasted time. Once in the patient’s home, stay on task and have a plan. Remember why you are there and execute the job at hand, while also making the patient feel important and involved. Focus on the patient and their needs. Do not allow the visit focus to turn to anyone else. Build trust and a good rapport with the patient as the opportunities present themselves. Assist the patient in understanding what to expect. Be attentive to their concerns, but do not allow the visit to be consumed by Q & A. Remove distractions as needed. Personal distractions should be avoided, such as cell phones or a preoccupied mindset. Distractions within the home may also need to be addressed (for example: pets, a loud TV or music, too many people around). Go into every visit with end goals in place and conduct the course of the visit in a way to get closer to meeting those goals. If the visit begins to veer of off the course you have planned, politely redirect its path. Accurate Documentation Is Good For Patients and Clinicians  Paint a true picture of your patient and their living conditions. This can often lead to an MSW or therapy referral to meet types of needs that may never be identified in a facility setting. Remember, if it isn’t documented, it didn’t happen. Therefore always be thorough in this part of your care. Make eye contact as much as possible, but attempt to jot down important information that you are gathering as you go. Start observing as soon as you pull into the driveway. Look at the yard, front porch and the condition of overall surroundings for safety hazards and concerns. Note who answers the door. If it is the patient, assess their speech, gait, demeanor, etc. from the very beginning to assist you in your overall assessment. Observe the cleanliness of the home and how it may impact the patient and their care. Be aware of the other people in the home. Keep the patient’s safety and your own safety as top priorities. Make sure you speak clearly and in a manner that the patient can understand. Use common terms and explain procedures, plans, and paperwork. Exhibit warmth and empathy through your communication. Overcome barriers – speech, hearing, and vision then note whether specific therapy referrals are appropriate. Listen to the patient and address their needs, requests, and concerns. Their involvement in the visit, development of Plan of Care, and overall outcome will be determined by the visits. Communication extends to within the home health agency as well. Always provide a report time to other clinicians that will follow you into a home. It is also a good practice to attempt to inform the patient of who will be included in the care. The new Conditions of Participation place a strong emphasis on care coordination. Watch For Signs Patient safety is an essential factor that the visiting clinician must assess. Monitor family members to gauge any suspicious behavior that is indicative of abuse or neglect. Be aware of what the signs are of elder abuse. Be mindful of animals, especially dogs. Anticipate problems and position yourself close to the door with ease of exit at any point during the visit. Maintain your car and gas. Be available to leave on a second’s notice. Keep your cell phone charged and always have a plan. If a situation arises, stay calm. Do not be manipulated by anger, fear, or sadness. Plan the visit in a way that eases the patient into the uncomfortable subjects at the right times. Be empathetic by stating the obvious, that things are personal and somewhat uncomfortable to talk about. Make sure to document any behavior that is aggressive. Report concerning behavior to the Clinical Manager and physician, as these situations need to be addressed quickly to prevent escalation. Patients of advancing age fear the loss of independence. Assure your patient that they are still involved in their care and remind them of their rights. Being a provider can take a toll on someone physically, emotionally, and mentally. Take time off when needed and minimize the time you take work home. Don’t be afraid to ask for help or for a break. Advocate for your patients and yourself. References: http://Cdss.ca.gov http://allnurses.com/home-health-nursing/10-tips-for-292108.html http://elderabuse.stanford.edu/screening/signs.html https://www.brightfocus.org/alzheimers/article/warning-signs-elder-abuse-and-tips-caregiver http://www.preventelderabuse.org/elderabuse/communities/advocacy.html
To watch Tips & Trips on Making the Most of Your Home Visits live presentation fill out your name and email address

Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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CoP Compliance – You Can’t Do It Without Your Clinicians!

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Clinical Documentation Improvement, Clinical Practices, Coding, Compliance, Conditions of Participation (CoPs), HIPPA, Uncategorized

CoP Compliance: You Can't Do It Without Your Clinicians!

CMS expects Conditions of Participation (CoPs) 100% Compliance on January 13th.

 
"January Funk" Shortly after ringing in the new year, people have been known to get the blues. Winters are cold, days are short, there’s not another holiday for months, and many people fall into what some call “The January Funk.” If you work in an industry that involves a lot of regulatory involvement, like healthcare, you may fall into a “January headache.” In healthcare, guidance, policy, and regulations are often updated, and new programs are launched at the beginning of the calendar year. For home health providers, saying “goodbye” to 2017 means saying “hello” to updated Conditions of Participation (CoPs) from CMS in 2018. After researching hundreds of pages of documentation, your head may be spinning as you lament over where to start. After all, just working in the home health business can keep your mind busy 24/7, never mind having more heaved onto your plate. With the new CoPs implementation quickly approaching, we’re in the warm up phase right now. If it hasn’t happened yet, it’s time for you to gather your team and start your pep talk. The success of any home health agency depends on teamwork. That’s now a new concept. Now is the time that your clinicians need to start wrapping their heads around how their life is going to be changing because of the updated regulations. Do you already have a plan in place for communicating to patients with limited English language skills? Do your clinicians know what the Patient’s Rights are? Since clinicians are just weeks away from having to give a verbal explanation of the Patient’s Rights to the patients, it’s time to start rehearsing. Clinician competency will be a key to your success, or the lack thereof will be the torpedo that sinks your battleship. Call your team together and let’s get the planning started. First, your team needs to know that these changes are coming, and that they are nothing to be afraid of. It seems that in healthcare when new policies (or regulatory changes) come around there is the feeling of impending doom. “What do we have to do now?” I recommend that you do an overview with your clinicians and let them know what exactly are the conditions of participation and why they are being updated. It’s time to discuss the paradigm shifts regarding CMS’s approach to patient care. It also may take a certain degree of convincing to get your long time veteran clinicians to buy into the idea of patient centered healthcare that is driven by the patient’s strengths and preferences. If your staff doesn’t buy into this new philosophy, there’s little chance that your patients are going to be convinced to shift their thinking. Eliminate Potential Anxiety For Your Clinicians After you get past the “why”, it’s time to get your paper out and start sketching out the “how.” Your clinicians need to clearly understand what part of their routine must change. What signatures do they need to get and when? What’s the phone number for the interpreter’s line? Are you going to publish your agency’s literature in different languages? How do you explain a patient’s right to people with different educational backgrounds and different cognitive ability? Your clinicians are much more likely to be compliant with the updated Conditions of Participation if you help eliminate some of the potential anxiety that accompanies change. Start talking about these things now. It’s not fair to throw clinicians into a new situation without the proper preparation. We’ve all been there, and we all know that it stinks to be there. Start coaching them now so they’re set up for success. Develop tools to get the job done right. Are there different fields that need to be custom added to your EMR so that the additional required information will have a home? If that’s not possible, you should work with your team to develop check lists (or worksheets) so that they are reminded of everything they need to ask or say during that home visit. Look at the tools you have now and decide what changes need to be made. When clinicians are forced to “do things on the fly” without the proper tools, they often find themselves jotting down random information in a disorganized and in a “non-HIPAA compliant” manner. Eventually, when this all of this becomes more familiar, your clinicians will probably develop their own system. While they’re just becoming accustomed to these new requirements, make sure they have the tools to be organized and efficient. Five-Day Window Coordination is a huge factor in the new Conditions of Participation. For coordination to be successful, good communication is a must. Unfortunately, communication is where many teams take shortcuts. The Clinical Manager role that is defined in the CoPs is immense. An agency’s Clinical Manager is only going to be successful if your team has a great communication plan. Communication about a patient’s care plan will be ongoing but it will be especially hectic at the time of admission. The communication plan among clinicians of different disciplines, multiple doctors’ offices, and the administrative staff, must be well thought out, organized and adhered to. Figure out how you’re going to manage all the information in the beginning five-day window, or your Clinical Manager may end up climbing out of the office window to escape. Practice, Practice, Practice! Finally, it’s time for your team to start practicing. There’s nothing that prevents you from implementing some of these changes before the beginning of the year. CMS expects you to be compliant with the updated Conditions of Participation 100% of the time on January 13th. Don’t wait until early one January morning to try and throw these ideas together. You’re not making a quick regulatory snack. You’re creating a huge feast of regulatory changes. Some of us know from experience that you shouldn’t be making your grocery list the day before Thanksgiving as your in-laws are in route to your home. Don’t wait until the beginning of January to bring in donuts for your clinical team so that you can “brainstorm this new thing.” Your clinicians are a key to your Conditions of Participation compliance. Invest in them. Train them. Listen to them. Invite them to join in on important conversations. Their success will lead to good patient outcomes. Isn’t that why we’re doing this after all? For more information about the implementation of the new Conditions of Participation please view our webinar from October. https://www.selectdata.com/clinicians-role-conditions-participation-cops-compliance-select-connect-clinicians/ For more information on this topic or on our USA based Document review and Coding Services or Revenue Cycle Management, please call Select Data at 1.800.332.0555.
Related Article - CoPs Breakdown On The QAPI Regulations
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians Click here to read more.

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New ICD-10 Code Updates: Ask the Right Questions to Get the Right Code

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Clinical Documentation Improvement, Clinical Practices, Coding, Healthcare, ICD-10 CM, OASIS-C2, Uncategorized

New ICD-10 Code Updates: Ask the Right Questions to Get the Right Code

CMS releases updates to the ICD-10-CM coding manual

 
Every October, the CDC and CMS release updates to the ICD-10-CM coding manual. These updates include both codes in the tabular and alphabetical indexes as well as official guideline changes. The following is a summary of some of those changes that Home Health Agencies need to know about.
  • Non-pressure ulcers now have 3 new code subcategories to include those ulcers that are down to the muscle or bone but do not have necrosis and for those ulcers that have tendon/ligaments showing. The clinician should always document the severity of the non-pressure ulcer in terms of skin breakdown, fatty layer, muscle exposed, muscle exposed with necrosis, bone exposed, bone exposed with necrosis, or other appropriate descriptive terms (tendon/ligament, hard eschar, slough obscuring wound bed, etc.).
  • C Diff is now being captured as being recurrent or not stated as being recurrent. Recurrence is defined by complete resolution of C diff symptoms while on appropriate therapy, followed by subsequent return of diarrhea and other symptoms after treatment has been stopped. Recurrence usually occurs within one week after treatment stops but may happen up to 8 weeks later. The physician would need to confirm whether C diff is recurrent or not.
  • Types of myocardial infarctions now play a role in determining the appropriate ICD-10 code. Type 1 is the most common MI which is associated with ischemia and due to primary coronary even. Type 2 MI is due to imbalance in supply and demand of oxygen. Type 3, (which we wouldn’t see in home health), is sudden cardiac death, including cardiac arrest. Type 4 MIs are associated with percutaneous coronary intervention while type 5 MIs are associated with a CABG procedure.
  • Secondary pulmonary hypertension diagnosis code has been further detailed to describe what the condition is that is causing the secondary pulmonary hypertension, including left heart disease, lung disease, etc.
  • Lumbar stenosis should be classified with or without neurogenic claudication. Neurogenic claudication is leg pain with walking. The physician must confirm neurogenic claudication for it to be coded.
  • Bowel obstructions can now be captured as complete or incomplete/partial. Complete bowel obstructions would need surgery to correct while incomplete/partial bowel obstructions can be sent home for it to resolve. The coding specialists need to know whether a bowel obstruction is resolved upon discharge from the hospital. Resolved conditions cannot be coded in home health except for in OASIS items M1011 and M1017 when they reflect the patient’s recent history.
  • New coding guidelines state that if a patient’s visual category is not documented then coding specialists can only code unqualified visual loss. It would be beneficial to query the physician to determine patient’s visual category to be more specific with coding of low vision and blindness. Also, the laterality of the low vision and blindness is necessary in retrieving the most specific code.
Along with these changes come the need for increased specificity for diagnoses. To assign specified codes, coding specialists rely on clinicians and physicians to provide adequate detailed information about each diagnosis being listed on the plan of care. Without this important step, coding specialists are left to code only unspecified diagnoses, which could impact reimbursement, or cause a delay in coding as a query may be necessary. To reduce queries to your clinical leadership and clinicians, here are some tips on being proactive with detailed information:
  • Query the provider for specifics that are not included in the physician documentation prior to completing assessment.
  • Specify sites and laterality of wounds
  • Specify etiology of wounds (surgical, traumatic, diabetic, arterial, venous, etc)
  • Query the provider for late effects of CVA if there are none documented in clinical paperwork
  • List the type of MI the patient experienced
  • Always document patient’s smoking/tobacco use status (current or history of, and what product)
  • Don’t list diagnoses on the plan of care that are not actively being addressed or impacting the plan of care
  • If there are diagnoses listed on the plan of care that will likely impact it, but no direct interventions regarding those conditions are present, document how they will impact the POC
  • Document if patient’s substance disorders are in remission per physician documentation or query to determine this.
  • Document the specific type of heart failure a patient has been diagnosed with
  • Specify which type of diabetes a patient has been diagnosed with, and what, if any, manifestations are present.
For the coding specialists to capture more specific diagnoses based on the clinician’s documentation, clinicians should document in the clinical note that this specific information was provided by the physician. Clinicians can document specificity but unless there is verbiage stating that the condition is physician confirmed, the coding specialists cannot code that specific condition. Select Data enjoys working closely with clinicians to provide the codes being captured in the plan of care. It is truly a team- work experience. If you have any OASIS review or Coding questions please call Select Data at 1.800.332.0555.
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians Click here to read more.

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The Clinician’s Role in Conditions of Participation (CoPs) Compliance | Select Connect with Clinicians

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Clinical Documentation Improvement, Clinical Practices, Coding, Compliance, Conditions of Participation (CoPs)

The Clinician's Role in Conditions of Participation (CoPs) Compliance

Live Recording from October's Select Connects With Clinicians

 
In this session, attendees will be able discuss the importance of Conditions of Participation (CoPs) and compliance with Home Health patient care.

Conditions of Participation (CoPs) Compliance Overview:

    • A New Model for Home Health Patient Care
    • How did we get there?
    • Reducing Risk
To watch The Clinician's Role in Conditions of Participation Compliance live presentation fill out your name and email address

Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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Top 5 Questions Home Health Providers Ought To Be Asking About HHGM

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Healthcare, HHGM, OASIS-C2

Top 5 Questions Home Health Providers Ought To Be Asking About HHGM

HHGM-Game Changer?

 
HHGM proposal is expected to reduce Medicare payment to providers by up to $4 billion. Unlike the current system, the groupings model doesn’t rely on the number of therapy visits performed to influence payment. It instead will rely heavily on clinical characteristics and other patient information such as diagnosis, functional level, comorbid condition and admission source according to CMS. The changes to the payment system would address the issues MedPAC identified in the home health PPS March 2017 report that noted both the incentives and the payment levels in the current payment system needed to be overhauled. Following the recommendations from the MedPAC report, Congress is attempting through new legislation to provide the Secretary of DHHS the authority to make assumptions about provider behavior, provide notice of those assumptions and implement them through comment rule-making in CY 2019. Top 5 questions Home Health Providers ought to be asking
  1. Is Congress giving the secretary authority to set payment without constraints? According to H,R. 3992 which was introduced in the House of Representatives on October 6, the Secretary would have the authority to set payments for 30 day periods and to revise that model through notice and comment rule-making.
  2. What consequences have occurred with the MedPAC reporting? It was MedPAC who suggested to Congress that providers had been adjusting their services based on reimbursement to increase financial margin. MedPAC has stated that the ACA rebasing provisions aren’t enough and that the appearance is that home health growth is slowing, it is still growing and only appears that way statistically because five states under pre claim review and increased scrutiny have decreased their utilization. MedPAC will continue to assess for trends related to reimbursement and provider response to those patterns.
  3. Is our industry under fire because of expected industry growth? Over the past decade, a lot of attention has been paid to the baby boomers turning the Medicare age of 65. This increase in potential patients is one of the reasons home health is expected to be the fastest growing marketplace in all of healthcare for the next decade. With 82.6% of Home Health patients over the age of 65, Medicare or a Medicare Advantage plan is responsible for a large portion of payments, as such the government has a vested interest in controlling costs. Healthcare costs are controlled by decreasing the volume of people using the service, decreasing reimbursement for the service and decreasing the cost of doing business.
  4. Can HHGM actually give me greater control over my payment? The higher degree of differences in potential payment, the more control over reimbursement received. What on the surface appears to be a model composed of more straightforward categorizations is, in fact, a differentiator. Does this mean the HHGM is without problems, no, but this will most likely be ironed out over the next year.
  5. What should I do in 2019? According to Elevating Home, an agency may expect a decrease in their Medicare reimbursement up to 17% with the new HHGM payment model. The new bill proposes that HHGM be delayed until CY2020 to provide organizations with the opportunity to prepare for the changes coming, but many providers may not know where to start.
Select Data has created SmartCare which has an HHGM predictive analytics model formed by our data science team that analyzes your historical episodes and compares them to the HHGM model to identify potential loss in revenue. SmartCare will be able to provide indicators to support these predictions and will have the capability to offer observations to prevent potential loss using prescriptive analytics. With the information SmartCare can produce, providers have the opportunity to start implementing changes needed to combat the future decline in revenue. Some agencies may be more prepared than others, but with the significant impact HHGM will make, isn’t it worth a conversation? Visit us at Booth 530 at NAHC to find out how to winFREE HHGM analysis.
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians webinar. Click here to read more. Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555.

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OASIS C2 and Active Diagnoses: Are Your Agency’s Answers Setting You Up for Potential Issues?

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Clinical Practices, Coding, Conditions of Participation (CoPs), ICD-10 CM, OASIS-C2

OASIS C2 and Active Diagnoses

Are Your Agency’s Answers Setting You Up for Potential Issues?

 
OASIS C2 has proven to have caused difficulty for many agencies. One key reason is M1028. Agencies must remember that a physician must validate if a patient has diabetes and/or PVD/PAD. In addition, the physician must determine if the diagnosis is active. The clinician cannot make that determination.   The OASIS Manual explains that these diagnoses influence the patient’s functional outcomes or risk for developing pressure ulcers. These are keen areas of concern to CMS. As a result, CMS is paying close attention to active diagnoses. Conditions that are resolved are not listed. Most patients with diabetes or PVD/PAD will have those as an active diagnosis but a clinician must not jump to conclusions. A physician must confirm the diagnosis is active and the agency should note that confirmation date.   The Clinical/Coding specialists should review the patient’s clinical record carefully for documentation to support the diagnosis and the plans for care. Review the medication profile, the comprehensive assessment, and the visit notes for related information as well as for congruency between the documentation. Pay close attention to M1028 but also to all active diagnoses.   Per CMS, active diagnoses are diagnoses that have a direct relationship to the patient’s current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at the time of the assessment. Note that CMS is honing in on the functional, cognitive, and behavioral status of the patients. It appears they are looking closely at active diagnoses, certain specific diagnoses, as well as the assessment of the patient…a very comprehensive assessment. They expect the assessment to support the diagnoses.   In the new Conditions of Participation (CoPs), CMS states that the “comprehensive assessment must identify the psychosocial, functional, and cognitive status of the patient including evaluating and screening any patient psychological and social condition that may complicate HHA service delivery or inhibit the patient’s ability to understand, remember, and participate in developing and implementing the plan of care.”   In summary, carefully answer M1028 but note all diagnoses must be confirmed by a physician. Be certain those confirmations are documented. Expand your comprehensive assessment to have a detailed psychosocial, functional, and cognitive assessment.   Remember, assessment and diagnoses are a focus of CMS. Make them your focus also.  For expert documentation review and coding, contact the Select Data Specialists.
Check out our FREE 30-minute webinar for OASIS-C2 corrections and more. Select Connects with Clinicians Click here to read more.

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What is Medical Coding? – Coding and OASIS Review Services

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Clinical Documentation Improvement, Clinical Practices, Coding, Healthcare, ICD-10 CM, OASIS-C2

What is Medical Coding? - Coding and OASIS Review Services

With the implementation of ICD-10 have we seen an increase in patient outcomes?

 

ICD-10

Since the implementation of ICD-10 by the Centers for Medicare & Medicaid Services (CMS) on October 1, 2015 have we seen an increase in the shear number of procedural and diagnosis codes. Currently, there are 68,000 ICD-10-CM codes and 87,000 ICD-10-PCS codes compared to 14,000 ICD-9-CM codes and 4,000 ICD-9-PCS codes available (ACR, 2012). Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc. (AAPR, 2017). But, have we seen an increase in patient outcomes?

Quality Outcomes Matter

Luckily for our clients, Select Data had been preparing for the ICD-10 increase of codes months prior to the implementation. In addition, our professional medical coders & billers have an average of 8+ years of Coding experience. Furthermore, the Select Data Coding and  OASIS Review service improved revenue for our clients on average of 6% and a reported 40% reduction rate in hospital readmissions.

Our Process

It is not enough to review the entire integrated OASIS assessment for completeness and conguency. We query the agency clinician on incongruencies between the physician orders, clinical record and patient's condition. Our process changes the behavior because we engage the clinician when suggesting changes. So that you can focus on patient outcomes.

Our Motto

Driving outcomes guided by compassion, values and a sense of stewardship. Because patients are more than a number. Each deserves their own portrait. At Select Data, we code with an artist's brush, not a rubber stamp. We help you focus on patient outcomes. Check out our Coding and OASIS Assessment review services today!

Helpful Tip


With over 20 years of professional coding service experience in and   is uniquely qualified to mitigate operational challenges.

References AAPC (2017). What is Medical Coding? Retrieved from: https://www.aapc.com/medical-coding/medical-coding.aspx American College of Radiology (2012). Prepare Now for ICD-10-CM and ICD-10-PCS Implementation. Retrieved from: https://www.acr.org/Advocacy/Economics-Health-Policy/Billing-Coding/Prepare-Now-for-ICD10  

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