Advanced Search

Home Health & Hospice Week

Regulations:

Beware This Grouper Diagnosis Coding Change

Published on Fri Jan 20, 2012

Outlier adjustments, OASIS updates, and more discussed in latest Open Door Forum. You'll have to rely on your own devices to keep your diagnosis coding correct under the home health prospective payment system grouper now in effect. Old way: Formerly, the PPS grouper issued a data validation flag when home health agencies listed a manifestation code on a claim that would pay under PPS, but it lacked the required etiology code, explained Rich Fuller with CMS grouper contractor 3M. The flag wasn't intended to help agencies maximize payment, Fuller stressed in the Jan. 11 Centers for Medicare & Medicaid Services Open Door Forum for home care providers; it merely provided an opportunity for HHAs to check their diagnosis codes for errors, he explained. New way: Under the new grouper that took effect for claims submitted Jan. 1 or later, the etiology and manifestation codes no longer have to be adjacent [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All