Home Health & Hospice Week

You may have to adjust your PT eval timing, according to CMS.

If you feel like there are a million things to do between now and Jan. 1 with little time to do them, you're not alone.

Attendees at the OASIS Certificate and Competency Board's first annual conference in Baltimore Nov. 12 were feeling the same way. "There's not enough time to do this," exclaimed one attendee during the session examining how the prospective payment system grouper will use OASIS data to calculate payment levels.

More attendees told Eli they hadn't started their PPS refinements staff training yet.

But diagnosis coding of your patients shouldn't change, stressed Abt Associates' Henry Goldberg in the session. "You're not supposed to change anything," he said of diagnosis coding. "Don't mold your coding to the new guidelines."

You should already be coding your patients and completing OASIS accurately, Goldberg noted. Just continue to do so and work toward understanding how that will affect reimbursement under the prospective payment system refinements that take effect Jan. 1.

"Paint the picture of your patient" with diagnosis coding, urged Sparkle Sparks with OASIS Answers in the session. Don't focus on whether it brings you more reimbursement, but whether it accurately depicts the patient, said Sparks, who taught two days of intensive coding training at the OCCB conference Nov. 13 and 14.

The new system is so complicated, it will be hard to change your coding to your advantage anyway, suggested Gene Tischer with the trade group Associated Home Health Industries of Florida. "Less than 1 percent of us are intelligent enough to game the system," he joked. It's a Brave New Coding World That said, the way diagnosis coding will affect payment will be changing drastically under PPS refinements, the experts admitted. The coding OASIS items, M0230/M0240/M0246, have a totally different look on the assessment form--a four-column box asking on one line for 1) the M0230 primary or M0240 other diagnosis description; (2) the corresponding ICD-9 code and its severity; (3) the M0246 case mix diagnosis if it's bumped out of column 1 and 2 with a V code (optional); and (4) the M0246 case mix diagnosis if it's a manifestation code that was bumped (optional).

PPS will use codes from all six lines in the box, Goldberg stressed. "It's important to pay attention to all six positions," he advised.

Remember: Only one diagnosis per line in the box scores case mix points, he reminded attendees. And for bumped case mix and manifestation codes in M0246 to count, they must correspond to the correct V code or etiology code on the same line.

"Welcome to the new world," said Pat Sevast with the Centers for Medicare & Medicaid Services in a separate session at the conference. The new [...]