Home Health & Hospice Week

Use these 5 pointers to get ready for critical payment changes in a few months.

You need to put the pedal to the metal for prospective payment system refinements training or risk major losses starting Jan. 1.

Home health agencies cannot wait until Jan-uary to train staff on the drastic PPS changes that will take effect then, warns consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville. "They need to train now."

"This is not a time to let the potential volume of work overwhelm agencies," urges consultant Regina McNamara with Kelsco Consulting Group in Cheshire, CT. "This is a time for action."

To combat PPS overload, sit down now to draw up your PPS refinements implementation plan, recommends consultant M. Aaron Little with BKD in Springfield, MO. At the top of it should be training, he tells Eli.

Heed these expert tips on how to conduct successful PPS refinements training:

1. Educate management. "If management doesn't have a clear understanding of the changes, it will be difficult for the rest of the agency to learn and adapt," Little cautions.

Assemble the management team, including top management and at least one representative from each department (clinical, financial, billing, IT, etc.), for a general overview of the changes included in the PPS refinements final rule that the Centers for Medicare & Medicaid Services issued Aug. 22.

Managers may benefit from attending educational sessions such as those offered by Eli, Little points out.

After being versed in the new system, management can together strategize on how to train their respective departments in the areas relevant to them, Little suggests.

2. Provide an overview to staff. Not every staff member needs to know the ins and outs of every PPS change. For example, a frontline nurse probably won't need to learn the details on how billers will enter non-routine supplies (NRS) into billing software.

But all staff can benefit from a general yet concise overview of the PPS changes. Don't let clinicians think they shouldn't care about financial issues and vice versa, exhorts consultant Judy Adams with Larson-Allen based in Charlotte, NC.

"Training clinicians on the financial impact of care plan options has helped to raise their awareness of resource use and improved the care planning process," Adams maintains. Education on financial consequences helps to "marry the desired outcomes and goals with the resource use necessary to achieve those goals."

3. Target clinical topics. HHAs will quickly need to drill down to specifics for different personnel to make training effective. "Keep the information targeted so that it's meaningful to each group of individuals," Little counsels.

Frontline clinicians should first learn about episode timing (M0110), how the four-equation model works and changes to case mix scoring, Adams suggests. The interaction between diagnosis codes and OASIS functional domain items for case mix is new and will be challenging for clinicians to grasp at first.

Hot spot: You'll also need to address diagnosis coding by itself, advises Chicago, IL-based regulatory consultant Rebecca Friedman Zuber. Starting Jan. 1, PPS will count diagnoses in all six places in M0230 toward case mix.

Agencies "need to work out how they are going to fine tune their selection and sequencing of diagnoses," Zuber notes. Coders must keep in mind that they should represent, in descending order of importance, what the care plan aims to address.

Big change: And don't forget a major education push on therapy. Many agencies should turn from emphasizing the "right number" of therapy visits to what's most appropriate for the patient and how to best utilize therapy visits, McNamara says.

HHAs should prepare for major scrutiny of their therapy documentation under PPS refinements, Gaboury warns. Agencies whose therapy practice patterns change, especially if they start reaching the 14-visit threshold, will see major medical review, she predicts.

4. Define other topics. Other departments will need their own individualized training. For finance, recognizing costs and revenue will be more important than ever under PPS refinements, Mc-Namara stresses.

Billers will have to learn a whole new set of HIPPS codes that CMS hasn't issued yet, Adams points out. They'll also focus on including non-routine supplies (NRS) costs on claims.

Don't forget: Marketers shouldn't get by without training, McNamara adds. "It is important to re-analyze the sales strategy for those selling and marketing agency services," she advises.

IT will have a whole host of software issues to deal with, she says.

5. Keep training manageable. If you throw the entire PPS refinement book at staff immediately, they may get overwhelmed, Adams warns. "Providing training for clinicians in small pieces with examples is more effective than trying to train on everything at one time," she tells Eli.

Do this: Keep education to "manageable do-ses," Little agrees.

Editor's note: The PPS final rule is at www. cms.hhs.gov/quarterlyproviderupdates/downloads/cms1541fc.pdf. For information on Eli's PPS audioconferences, including sessions by Judy Adams and M. Aaron Little.

For more PPS refinements preparation tips, see future issues of Eli's Home Care Week.