Posted on: August 8, 2019 by Manchester Specialty
Diagnosis coding has always been important in home health care, and continues to be, particularly in light of changes under the new case-mix classification model, the Patient-Driven Groupings Model (PDGM), which is set to become effective January 1, 2020. Once PDGM replaces the Home Health Prospective Payment System (HHPPS), proper documentation, outcome and assessment information set (OASIS) accuracy and correct coding will have a direct impact on episode payment. It’s, therefore, important home health care providers are vigilant about educating their coding staff.
Following are best practices you can share with your insureds for their home health care staff to follow to ensure coding is done correctly, courtesy of Healthcare Provider Solutions (HPS), which provides financial, reimbursement, billing and clinical consulting to the home care and hospice industries:
Following are coding issues that indicate red flags to an auditor:
Note: Under the PDGM, the Centers for Medicare & Medicaid Services (CMS) has identified 43,287 ICD-10 codes (out of 68,000) as valid primary codes and has mapped each to one of the 12 clinical groupings. All other ICD-10 codes are not considered valid primary codes. Using a non-valid code as primary will result in a submitted claim being returned to the agency for code adjustments, which has potential long-term consequences. Regulatory authorities will likely scrutinize agencies that repeatedly submit non-valid codes as primary.
Manchester Specialty provides a total business insurance solution for home health care providers, including Regulatory Audit Coverage (RAC) for providers that have been penalized or fined in association with the unintentional overbilling of Medicare, Medicaid, and commercial payors. We also can provide the following insurance lines to your clients: General Liability, Professional Liability, Workers’ Compensation, Management Liability, Cyber Liability, and Non-Owned & Hired Auto insurance, among other key coverages. For more information about how we can help you protect your insureds, please contact us at 855.972.9399.
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Posted in: Home Healthcare Providers