Home Health & Hospice Week

How is your vendor handling extra diagnosis codes?

You don’t want problems with securing orders or pinning down diagnosis codes to delay your claims submissions under the Patient-Driven Groupings Model. But you also need to make sure your software is ready to support the changes you’re making organizationally.

A crucial step in PDGM preparation will be to “stay on top of your billing software vendor to ensure that they are prepared,” emphasizes Rick Ingber with VantaHealth Consulting in Ardmore, Pennsylvania.

You shouldn’t wait until PDGM gets closer to check in, warns consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. “Hold discussions with software vendors now regarding their progress in readiness for PDGM,” Warmack urges.

Your vendor doesn’t need to have everything ready now, particularly with key elements like the grouper, base rate, etc., not final. But “HHAs need to reach out to their software vendors and find out what steps have been taken and what is still being planned to implement PDGM,” says Diane Magrady, compliance lead with Morton Grove, Illinois-based Pragma-IT, creator of the therapyBOSS therapy documentation software solution.

Try this: “Make a ‘Needs’ versus ‘Wish’ list for the vendor,” Warmack suggests. “Make certain they will be ready to meet your ‘Needs’ list by Jan. 1, 2020.”

Also, “ask them about any changes they are planning that may help ease the burden for billing staff,” Warmack advises.

Zero in: Under PDGM, diagnosis codes will have a bigger role in determining payment than under the current PPS. Agencies should “check with their EMR vendor to determine where the billing information comes from and if [its software] will allow capture of the increased number of diagnoses to support the PDGM Comorbidity Adjustment,” stresses Joe Osentoski with Quality in Real Time in Troy, Michigan.