Webinar: Ask the Experts: Home Health & Hospice Coding

Coding is one of the most important aspects of your agency’s operations. Errors in coding can cause delays in reimbursement, or worse – denials. Reimbursements are the key to financial stability, and this stability allows you to deliver care at the highest levels.

PDGM Record Audits

Your records provide a wealth of information. Fazzi’s expert auditors will conduct the following reviews of your records to uncover areas needing attention for success under PDGM.

  • Coding and OASIS Audit: The PDGM case mix relies on accurate primary and secondary codes and an accurate assessment of OASIS functional Items. Fazzi will conduct a side by side audit of your ICD-10 codes and key OASIS Items to assess accuracy and uncover areas where clinician education is needed. We’ll provide insight on codes that will not be accepted under PDGM and on OASIS Items that impact patient outcomes and the functional assessment portion of the PDGM HHRG calculation.
  • Plan of Care Compliance Audit: It’s important to remember that while PDGM changes payment calculation, it does not change the Conditions of Participation or other regulations. Excellent documentation will be essential as increased scrutiny will continue under PDGM. Fazzi’s full compliance audit will provide you insight on the level of excellence with overall documentation including evidence of eligibility, case coordination for PDGM clinical groups and, adherence to supplemental orders.
  • LUPA Audit: PDGM will create additional complexity in managing LUPAs with different thresholds for each clinical grouping. Preparation begins with an analysis of your current practices. Fazzi’s LUPA audit will help you determine whether LUPAs tend to be appropriate or not and – why. Fazzi auditors will review an entire episode to provide you information on gaps and successes with LUPAs that will help you prepare for the new range of LUPA thresholds in PDGM.

The minimum sample size for each audit is 20 records.

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Maximize Accurate Reimbursement and Control Risk under PDGM

As the leading outsourced coding firm in Home Health, Fazzi has a proven track record of accurate and timely coding and record review services that provide valuable feedback to clinical teams.

Under PDGM our new coding service, Payment Period Coding Review, will utilize the overlap of the end of each quality episode with each payment period transition at day 60, 120, 180, etc.. to review the REC OASIS for appropriate coding. These OASIS timepoints can then be used as a source of accurate coding for the coinciding claims at the payment period transitions.

If you are concerned about how your agency will handle coding updates at payment period transitions on day 30, 90, 150, etc., Fazzi can help. The Fazzi Coding team will review patient record coding at each payment period unassociated with an OASIS timepoint. Utilize this service to ensure claims are accurate to the patient’s presentation at each 30-day interval.

Fazzi’s Payment Period Coding Review will:

  • Maximize opportunity for accurate payment across all payment periods
  • Control risk
  • Alleviate workforce burden

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Targeted Probe and Educate in Hospice – Learn How to Prepare

Fazzi has partnered with WellSky to present this free webinar.

As the regulatory scrutiny of hospice care continues to intensify, Medicare Administrative Contractors (MACs) are identifying hospices for Targeted Probe and Educate (TPE) in record numbers. While the Targeted Probe and Educate program is intended to impact providers (and ultimately patient) in positive ways, these reviews can be time consuming, challenging, and stressful for hospice leaders. How will you prepare if your hospice is identified for a TPE?

In this important 60-minute presentation, Catherine Dehlin, RN, BSN, CHPN, CHCM, Director of Hospice, will help you understand TPE and learn how to get the most out of this important process.

Attend and learn:

  • The rationale and objectives of TPE in hospice
  • The typical TPE process for most MACs and the ideal response for hospice providers
  • The aspects of hospice performance that agency leaders should monitor regularly

Don’t miss this opportunity for you and your team to learn from one of hospice’s most influential thought leaders!

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Webinar: Targeted Probe and Educate in Hospice – Learn How to Prepare

Fazzi has partnered with WellSky to present this free webinar.

As the regulatory scrutiny of hospice care continues to intensify, Medicare Administrative Contractors (MACs) are identifying hospices for Targeted Probe and Educate (TPE) in record numbers. While the Targeted Probe and Educate program is intended to impact providers (and ultimately patient) in positive ways, these reviews can be time consuming, challenging, and stressful for hospice leaders. How will you prepare if your hospice is identified for a TPE?

In this important 60-minute presentation, Catherine Dehlin, RN, BSN, CHPN, CHCM, Director of Hospice, will help you understand TPE and learn how to get the most out of this important process.

Attend and learn:

  • The rationale and objectives of TPE in hospice
  • The typical TPE process for most MACs and the ideal response for hospice providers
  • The aspects of hospice performance that agency leaders should monitor regularly

Don’t miss this opportunity for you and your team to learn from one of hospice’s most influential thought leaders!

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How Many More Claims Will You Need to Bill Under PDGM?

One of the many sweeping changes under the Patient-Driven Groupings Model (PDGM) is the move to 30-day payment periods. Diane Poole, long time industry expert and the Director of Fazzi’s outsourced billing department, has created a position paper to address the implications of this change on billing capacity and cash flow. Specifically, in this position paper you’ll learn:

  • Predictions on increased claim submissions by agency size (based on CMS data) and how that impacts the associated workload in your billing department.
  • The impact on cash flow from “Half the RAP”.
  • How Fazzi will help our outsourced billing clients with these challenges.

Continue reading “How Many More Claims Will You Need to Bill Under PDGM?”

What the FY 2020 Proposed Rule Means for PDGM and Coding

CMS has issued the FY 2020 Proposed Medicare Home Health Payment Rule which of course encompasses far more than the proposed payment rates. In particular, the industry has wondered what, if any, changes CMS would make to the Patient-Driven Groupings Model (PDGM) set to go into effect on January 1.

In this complimentary webinar, we provide an update on the portion of the Rule that encompasses PDGM and in particular what we believe to be the impact on agencies’ coding operations, challenges and imperatives.

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Hospice Compare Updated

CMS posted the quarterly Hospice Compare refresh of quality data on August 15, 2019.

All quality measures improved since the last quarterly posting or stayed the same. Pain Assessment and Composite Process Measure showed the most improvement each with a 1.1% increase. Pain Assessment improved from 89.2% to 90.3%, and Composite Process Measure, from 85.3% to 86.4%.

A new quality measure, Hospice Visits When Death Is Imminent, has been added and posted at 82.3%. This measures the percentage of patients getting at least one visit from a registered nurse, a physician, a nurse practitioner, or a physician assistant in the last 3 days of life.

Updates to the family caregivers’ survey results showed all eight measures remained the same.

Quality measure results are from data collected October 1, 2017 – September 30, 2018, and Hospice CAHPS® survey results reported October 1, 2016 to September 30, 2018.

VIEW STATE LEVEL HOSPICE COMPARE CHARTS

PDGM Training Series and Financial Analyzer

8 Part Webinar Series

Click arrows to read webinar descriptions.

1.) Intake Strategies for Success with PDGM (September 11, 2019)

The Patient-Driven Groupings Model (PDGM) will dramatically affect the way home health agencies are paid. It also will have a significant impact on agencies’ operations, from intake through discharge. During this session we will walk agencies through the significant home health changes under PDGM and detail how agencies should adapt their intake process as a result. This includes strategies for getting detailed documentation, questions intake staff can ask to gather additional details necessary for accurate coding, and best practices for increasing efficiencies within the intake department.

Objectives:

  • Identify the ways PDGM will affect agencies’ intake departments.
  • Increase efficiencies within their own intake department.
  • Educate their intake staff about how to gather additional detail so that the agency can code as accurately as possible.
2.) Case Management and PDGM (September 18, 2019)

PDGM preparation, Value Based environment and new CoP compliance demands a changing level of performance by our field staff. Updating your agency’s case management practice and associated leadership focus will increase the value of your service to your patients and the performance of your agency.

Leadership of process and people requires a focused understanding of PDGM Key Performance Indicators (KPIs), as well as underlying Key Performance Behaviors (KPBs) needed to move the metrics in the right direction! This training will establish these PDGM building blocks for successful leadership of effective case management and will reinforce KPIs needed for your leadership dashboard.

Objectives:

  • Reinforce KPIs for success (LUPA rates, hospitalization, productivity).
  • Discuss the tools needed to achieve them and the leadership techniques needed to guide and sustain top notch performance.
  • Identify key case management strategies to achieve best-practice clinician performance.
3.) OASIS-D1 and PDGM (September 25, 2019)

The PDGM Functional Impairment Level is based on 8 key OASIS items. Including:

  • M1800: Grooming
  • M1810: Current Ability to dress upper body safely
  • M1820: Current ability to dress lower body safely
  • M1830: Bathing
  • M1840: Toilet Transferring
  • M1850: Transferring
  • M1860: Ambulation/Locomotion
  • M1033: Risk for hospitalization

How your staff answer these 8 items could significantly impact your functional score, HHRG calculations, and ultimately your reimbursement. Never before has it been more imperative that your clinicians know how to accurately assess their patients in the home to ensure they accurately respond to these key items. This educational session explains the importance of OASIS as the foundation of goal directed, patient-centered care planning and best practices for assessing the patient’s functional abilities.

Objectives

  • Discuss best practice strategies for answering the PDGM OASIS items accurately
  • Learn how to incorporate the OASIS Walk into the SOC/ROC assessment.
4.) Preparing Your Coders for PDGM (October 2, 2019)

One of the biggest changes with PDGM are the new guidelines for home health coding. In this session we review the twelve clinical subgroups and how comorbidities are impacting case mix in the PDGM. Discussion will focus on how coders can best prepare for the new model.

Objectives:

  • Recognize the twelve clinical sub-groups and unacceptable primary codes.
  • Identify common home health codes under each sub-group.
  • Describe the steps to prepare coders for PDGM coding.
5.) Coding Comorbidities with PDGM (October 9, 2019)

PDGM includes a comorbidity adjustment category based on the presence of secondary diagnoses. It will soon be especially important for coders to code all applicable comorbidities – as depending on a patient’s secondary diagnoses, a 30-day period may receive no comorbidity adjustment, a low comorbidity adjustment, or a high comorbidity adjustment. The comorbidity adjustment is impacted by the number of interacting secondary diagnoses.

Coders need to understand that additional coding will be needed to capture all the comorbidities but there is a delicate balance required as clinicians need to be addressing these diagnoses in the care plan. Using the PDGM Comorbidity Subgroups as a guide, we will review how to code comorbidities accurately.

Objectives:

  • Review the comorbidity categories & subcategories in PDGM.
  • Discuss the 11 comorbidity subgroups and included diagnoses.
6.) Care Management with PDGM (October 16, 2019)

PDGM changes the payment model significantly while the current Home Health Conditions of Participation including OASIS and eligibility criteria remain the foundation of our clinical practice. Efficient clinician workflows, proper utilization of all services and case management oversight are vital to success in PDGM.

Objectives:

  • Describe the PDGM case mix structure and key corresponding regulations.
  • Discuss effective and realistic case management practices.
  • Discuss key service utilization strategies, including LUPA management.
7.) Service Utilization Management Training (October 23, 2019)

Success in home health continues to require organizations to develop the core competency and capability of managing care in order to maximize quality patient outcomes and satisfaction scores at the lowest cost. With the onset of PDGM, agency leaders and clinicians must learn how to best assess their patients and plan goal-directed care using the most efficient and effective multi-disciplinary visits. Utilizing the appropriate services to meet care goals while remaining efficient is not only best practice, it’s imperative for the success of your organization.

Objectives:

  • Learn how to use data to drive successful utilization management.
  • Discuss strategies, such as frontloading and the use of signifigant change in condition, to develop patient centered plans of care.
8.) Billing and PDGM (October 30, 2019)

All live webinars are from 1-2pm Eastern and on-demand webinars provided.

Bonus PDGM Financial Analyzer

Click arrows to view reports.

Agencies who purchase the webinar series now will also receive free access to our interactive PDGM Financial Analyzer. Based on 2018 claims data, our PDGM Financial Analyzer gives you a comprehensive analysis of the projected financial impact of the Patient-Driven Groupings Model (PDGM) on your agency.

With the Financial Analyzer you’ll get detailed illustrations of your agency data – comparing the current Home Health Prospective Payment System (HHPPS) and the proposed PDGM model using 2018 claims data – including:

Primary diagnosis codes not tied to a clinical group and potential loss

Primary Diagnosis Codes Not Assigned to a Clinical Group

Nursing/Therapy visit ratios for agency top 5 primary diagnoses

Nursing Therapy Visits per Top 5 DX Per 30 Day Period

LUPA percentage of visits, payment, and LUPA payment by clinical group

Count showing LUPA Breakout

Payment and cost by functional group, admission source, comorbidity

Payment and cost by functional group, admission source, comorbidity

All provided with national and state benchmarks.

Combined with the training series, you’ll get the detail you need to understand what’s driving the projected change in your reimbursement and to create your PDGM Readiness plan. Be prepared with your PDGM data during the webinar series so that our presenters can walk you through your benchmarks.

Pricing for the PDGM Training Bundle (Includes PDGM Live series, video recordings and PDGM Financial Analyzer): $999 per site/CCN. For 6+ CCNS, $699. For 10 or more CCNs, contact us for pricing.

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Case Management Certification Course Begins October 14

case management credentials
You’ve been asking for it and now it’s finally here! The next preparation course for our industry’s only case management certifications, the Certified Home Health Case Manager (CHHCM) and the Certified Hospice Case Manager (CHCM), begins October 14.

Why are these credentials so valuable:

The upcoming Patient Driven Groupings Model (PDGM) payment reform and increased scrutiny of hospice require new levels of expertise. Today, case managers must master goal directed, patient centered care planning; clinical best practices; interdisciplinary team management; time management; documentation and more – all while putting the patient first and, yes, loving the job!

About the CHHCM and CHCM:

  • These credentials can be achieved by taking the CHHCM and/or CHCM examination online through the Fazzi Learning Center.
  • An eight-week online preparation course for these examinations begins October 14.
  • With the bundle package, participants may choose the Home Health Track or the Hospice Track or they may do both. They may also choose to take the CHHCM exam or the CHCM exam or pay a small upgrade fee to do both.
  • Certificate holders get a wealth of free resources. You’ll enter a collaborative community of case management professionals and receive ongoing complimentary best practice webinars and other resources.
  • Participants will be inspired by course instructor Cindy Campbell’s expertise, energy and zeal for case management

Have more questions about the Case Management certification? View our on-demand webinar or our comprehensive FAQs. Contact us at training@fazzi.com or (844)993-2994.

Register Now