Working through all the changes in PDGM can feel overwhelming. Now, consider your current ICD 10 coding system. If you are a small agency, then you might be doing it with an in-house staff member. This can be such a great option, but it can also set you up for problems if the coder isn’t prepared. Let’s look at some of the changes with coding that agencies will need to consider.
PDGM ICD 10 Coding Changes:
First, 40% of the current codes accepted in a PPS system will not be allowed as a primary diagnosis under PDGM. This is huge. It means there will be even more emphasis on referrals and what the primary reason for home health is. Agencies will need to verify the information prior to home health admission. The list of allowable ICD 10 primary diagnosis codes is available on the CMS website in the PDGM grouper tool. The time to make the changes is now and not January 1st, 2020. In-house coding staff should be coding for the PDGM changes now so non-allowable diagnosis are no longer part of your current admissions.
Let’s now talk about your software vendor. Find out where your software gets the diagnosis information to pull to the claim. In most cases, it gets pulled directly from the Oasis. PDGM only allows clinical groupings be assigned based upon the primary diagnosis listed on the claim. If it is pulled from the Oasis, in theory it should match. But, it is important your clinical grouping is determined by what you put in the claim as primary and not dependent upon what could be a wrong code on the Oasis. Your case mix weights will be more important than ever with PDGM decreasing the total number of case mix adjusted payment groups to 432.
What Do You Need To Prepare:
If you are a small agency using in-house non-certified coders to do your coding, then stop now. The loss of revenue based upon lack of coding knowledge can hurt you now more than in the past. Certified coders in your agency need to have this as their complete focus. Many small agencies have dual roles for staff including coders. It is not uncommon to see coding completed by the same person that functions as an admin assistant or a scheduler in the agency. There are too many changes that occur on an ongoing basis to have coders in multiple roles.
If you are in the group mentioned above, it is time to consider outsourcing. Small agencies may not be able to afford a full-time coder or be able to justify a full time position in coding. Outsourcing really is the key for these agencies. The other wrinkle in this comes with agencies that have grown approaching PDGM. You may have in-house coders but not be able to keep up with the number of admissions now coming into the agency. As PDGM comes, getting those items ready and coded properly in a timely manner will be critical, especially for those that CMS agency level impacts shows a decrease in anticipated revenue come January 1st, 2020.
Let Us Be Your Coding Headquarters:
At Kenyon Homecare Consulting, our goal is to help agencies move through change successfully both in clinical and operational departments. We have full-service coding that includes Oasis review and can take your agency up to and through the billing process should you desire. We can help educate staff through the transitions to make the PDGM change a smooth one. Call us at 206-721-5091 or contact us online for your 5 free re-codes and see how much revenue you may be leaving on the table!