Viewing posts categorised under: OASIS-C2

Tips and Tricks on Making the Most of Your Home Visits

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Educational Videos, Events, OASIS-C2

Tips and Tricks on Making the Most of Your Home Visits

Live Recording from December's Select Connects With Clinicians

 
In this session, attendees will learn tips and tricks on making the most of home visits.

Making the Most of Your Home Visits

Objectives

  • Understand the structure of home care visits
  • Understand the importance accuracy in documentation
  • Understand the safety for home care patients in skillset development
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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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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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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STAR Ratings and OASIS Accuracy | Select Connects With Clinicians

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Events, OASIS-C2

STAR Ratings and OASIS Accuracy | Select Connects With Clinicians

STAR Ratings and OASIS Accuracy

 

In this session, attendees will be able discuss STAR ratings history and application.

How did STAR ratings come into being? Two Acts Pave the way. The Affordable Care Act (2010) and the IMPACT Act (2014). Why should you care? STAR ratings are used as a reference when people are selecting healthcare providers. Patients are healthcare consumers. STAR ratings will impact a Home Health Agency's reimbursement. Select Data’s OASIS Review and Coding services improve the agency’s Star Ratings by ensuring the patient’s fragility is captured appropriately with each quality episode.  This allows the patients that can improve to be reflected in the STAR Rating calculation and those patients who are not likely to improve in that outcome measure to not be calculated in the agency’s Star Ratings.
To watch the STAR Ratings and OASIS Accuracy live presentation fill out your name and email address

 For more information regarding Star Ratings and OASIS Review and Coding services for your agency, contact us today!
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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Assigning Diagnoses and Developing a Plan of Care | Select Connects with Clinicians

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Events, OASIS-C2, Uncategorized

Assigning Diagnoses and Developing a Plan of Care | Select Connects with Clinicians

Assigning Diagnoses and Developing a Plan of Care

 

Webinar Overview:

The MD documentation, the diagnoses listed, the OASIS assessment and the plan of care have all got to agree. They are all parts of a cohesive units, or all chapters of the same book. As you go from one part of a patient's documentation to another part of the patient's documentation you should be able to obviously see that they are all describing the same patient. For example: If a patient has some type of wound you should see that wound addressed in the the MD documentation, the diagnoses coding, the OASIS assessment and in the plan of care. To watch the Assigning Diagnoses and Developing a Plan of Care 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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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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Wounds and OASIS Documentation

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Clinical Documentation Improvement, Educational Videos, OASIS, OASIS-C2, Wound Care

Wounds and OASIS Documentation Presentation

Wounds and OASIS Documentation Key Facts

 

Upon completion of this session, attendees will be able to:

  • Documenting surgical wounds
  • Identifying and documneting skin ulcers
  • Documenting other skin lesions and skin alteration
To watch the Wounds and OASIS Documentation 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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OASIS-C2 Presentation: Changes and General Guidelines (Webinar)

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Clinical Practices, Coding, Educational Videos, Events, OASIS-C2

OASIS C2 Presentation

What is important and staying the same? What is new?

 

Upon completion of this session, attendees will be able to:

  • Identify what OASIS-C2 is and what it provides
  • Identify the OASIS-C2 general conventions and conventions for ADL/IADL item
  • Identify item intent and item-specific instructions for OASIS-C2 Clinical items
  • Identify OASIS-C2 resources and websites
To watch the OASIS-C2 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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