It’s apparent that home health providers are struggling with efficient visit utilization under PDGM. By leveraging best practice episode management strategies, however, providers can drive efficient visit utilization, deliver high quality care and ensure financial viability.
Clinical documentation plays many roles within healthcare. It validates the patient care provided, supports coding decisions, and facilitates claims processing, billing, and reimbursement. But at its core, clinical documentation works as a narrative in telling the patient’s story – where the patient has been, what they are going through and what the future holds for them.
PDGM began officially in January 2020, and the COVID-19 pandemic exploded on the scene in March, making an already challenging time for home health.
Quality Assurance (QA) audits add support to home health care agency teams and ensure clinical documentation improvement and compliance.
Questionable Encounters are primary diagnosis codes that are not specific enough to support the need for home health services that result in a return to provider (RTP) and ultimately delays in payment.
CMS issued the CY 2020 Home Health Prospective Payment System Rate Update, which finalized changes for the Patient-Driven Groupings Model (PDGM) that will go into effect on January 1, 2020.
As the Patient-Driven Groupings Model (PDGM) is approaching, organizations are currently focusing on how it will impact revenue cycle functions. To prepare financially prior to PDGM’s implementation date of January 1, 2020, home health organizations can focus on cash collections to be prepared for any loss or delay in cash flow due to the significant changes under the new model and identify risks that could cause potential delays across the revenue cycle.
Home health organizations depend on their staff and tracking systems for a quick and efficient order management process. Order management is a key component within the revenue cycle process, as the collection of physician documentation is required to initiate any billing process. A bill cannot be generated without first obtaining all necessary orders.
For home health organizations, referral and intake directly impact an agencies core operations and ability to provide appropriate care and bill in a timely manner. PDGM adds a new layer of complexity to this process by introducing the 30-day billing periods and admission source.
