Home Health & Hospice Week

Diagnosis coding could make or break you in 2008.

The biggest changes to the prospective payment system since its inception will hit next month, so you'd better make sure you're on top of the revisions or risk major financial and operational hardship.

Here are the most critical issues home health agencies should tackle in preparation for the PPS refinements, according to experts: 1. Diagnosis coding. At a recent conference, a Centers for Medicare & Medicaid Services official stressed how much more significantly PPS will count diagnosis codes in M0230/M0240/M0246 toward payment. "It's no longer just primary diagnosis," noted the staffer. "It's not the same as before and it's not simple" (see Eli's HCW, Vol. XVI, No. 40).

In preparing for the PPS changes hitting Jan. 1, HHAs "need to work out how they are going to fine tune their selection and sequencing of diagnoses," advises Chicago-based regulatory consultant Rebecca Friedman Zuber. Coders should represent, in descending order of importance, what the care plan aims to address.

"They will need to do a good job completing M0230/240/246," Zuber instructs.

Do this: Educate your clinicians to identify all co-morbidities that the patient may have, suggests reimbursement consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN. However, those diagnoses must currently and directly affect the plan of care, Gaboury stresses.

Take a look at who is responsible for your coding and decide whether you want to change that, recommends consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT. Once you've settled on primary and backup coders, send them to get specialized coding instruction, she urges.

You may need to recruit expert coders to assure payment accuracy, suggests consultant Judy Adams with LarsonAllen based in Charlotte, NC. 2. OASIS accuracy. In 2008, how well your clinicians fill out OASIS will determine whether you get your rightful reimbursement more than ever before. "Critically examine your clinical staff's abilities to assess their patients," advises reimbursement consultant M. Aaron Little with BKD in Springfield, MO. OASIS accuracy has always been essential, but the PPS refinements "certainly heighten how crucial it is that the clinicians understand how to use the OASIS as a tool to assess patients," Little says.

"The new case-mix system is much more intricate," Little warns. There's more emphasis on how the M0 items relate to each other rather than how each individual M0 item is scored. That means one inaccurately scored case mix item could torpedo your whole episode's reimbursement.

Tip: If you haven't already done so, set up a regular system of testing staffers' OASIS competency, Adams recommends. "Based on results of the OASIS competency testing, HHAs can design individualized OASIS training on the specific topics needed for each person," she tells Eli. That avoids "subjecting all staff to [...]