Tips and Tricks on Making the Most of Your Home Visits
Making the Most of Your Home Visits
- Understand the structure of home care visits
- Understand the importance accuracy in documentation
- Understand the safety for home care patients in skillset development
New ICD-10 Code Updates: Ask the Right Questions to Get the Right Code
CMS releases updates to the ICD-10-CM coding manual
- 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.
- 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.
Top 5 Questions Home Health Providers Ought To Be Asking About HHGM
- 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.
- 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.
- 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.
- 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.
- 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.
OASIS C2 and Active Diagnoses
Are Your Agency’s Answers Setting You Up for Potential Issues?
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
What is Medical Coding? - Coding and OASIS Review Services
With the implementation of ICD-10 have we seen an increase in patient outcomes?
ICD-10Since 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 MatterLuckily 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 ProcessIt 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 MottoDriving 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. Coding and OASIS Assessment review services today!
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
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