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8. Thank you for joining us!
What to expect
Session is being recorded for replay Listen-only mode during the presentation
Submit questions via the Chat Panel Q & A sessions at the end The recording and slides will be shared on our
PDGM Resource Center

10. Speaker Brian Harris Consulting Director
BlackTree Healthcare Consulting
Speaker

11. Agenda
PDGM Summary
Operational Impact
Preparing for PDGM

12. PDGM SUMMARY

13. What is PDGM? CY 2019 Final Rule
Implementation date proposed to be for periods of care beginning on or after January 1, 2020
Budget neutral – huge win compared to the estimated $950M reduction in payment of HHGM
Replaces 60-day payment episodes with 30-day periods
Eliminates the use of the number of therapy visits in payment determination

14. What is PDGM? CY 2019 Final Rule
Increase total number of case-mix weights from 153 to 432
Modification to low utilization payment adjustments (LUPAs)
Model based on claims with through dates in 2017 that were processed by March 2, 2018
6,771,059 episodes
959,410 (14.2%) excluded due to non-linked OASIS
7,458 cost reports

15. What is PDGM?

16. OPERATIONAL IMPACT

17. Operational Impact: General
Education to all staff is essential
Strong interdepartmental communication
Reporting on key indicators driving reimbursement under PDGM
Recommend establishing an internal PDGM steering committee
Key Metrics to Monitor
Productivity levels for all departments
Staffing levels required to implement optimal workflows under PDGM

18. Operational Impact: Intake
Understand the impact of your primary referral source
Analyze current marketing and referral relations strategies
Includes education to referral sources
Obtain as much information as possible at time of referral
This will be vital in supporting coders
Strong communication with Scheduling Department
Minimize gaps in entry of referral information into EMR
Develop Intake checklist
Key Metrics to Monitor
Percentage of current referrals that are institutional vs. community
Most common clinical groupings referred by each referral source

19. Operational Impact: Case Management
Appropriate visit frequency at start of care
Interdisciplinary communication
Therapy still plays an important role in the care plan
LUPA management under new structure
Early identification of HIPPS allows for more effective LUPA management
Timely completion of OASIS/visit documentation
Continuing assessment of patient during care
ROC assessment/SCIC will change HIPPS under PDGM
Supply management
Key Metrics to Monitor
Turnaround time for OASIS completion/submission to CMS
Estimated LUPA percentage under PDGM
Average length of stay

20. Operational Impact: Billing
Volume of claims requiring billing/collections efforts doubles
For the first 30-day period in an episode, shorter timeframe to resolve all pre-billing issues prior to final claim being available to submit
Monitor claims to ensure no processing errors once new structure is implemented
Future of RAPs is uncertain
Communication with coders on Questionable Encounters
Key Metrics to Monitor
Days to RAP/final claim
Frequency of billing
Claim volume on outstanding accounts receivable
Volume of unbilled claims

21. Operational Impact: Changes in Claim Information
CMS will calculate reimbursement based on prior claims in common working file (CWF), diagnoses/visits on submitted claim and OASIS in QIES system, not HIPPS listed on claim
Need to investigate all remaining balances on A/R prior to adjusting off in EMR
Pricer not implemented until 1/6/2020
Occurrence Codes for institutional referral sources
OC 61 – acute inpatient hospital stay
OC 62 – SNF, IRF, LTCH, IPF
Occurrence Code 50 indicates assessment date
Treatment authorization code no longer required on claims

22. Operational Impact: Finance
Adapt accounting model to 30 day period format

23. PREPARING FOR PDGM

24. What can you do NOW? Determine estimated revenue impact
Agency-level detail available on CMS website under “Home Health Agency (HHA) Center” provider section
Download PDGM grouper
Limited Data Set (LDS) made available by CMS
Evaluate current processes and workflows
Are these sustainable under PDGM?
Evaluate current agency data for key PDGM indicators
Contact your Senators and Representatives to support legislation to eliminate the behavioral adjustment
S.433 just introduced by bipartisan group of Senators

25. National Impact
Estimated Impact by State

26. National Impact Estimated Impact Facility Type % Facility Based +3.0%
Free Standing
-0.3%
Nursing/Therapy Ratio %
1st Quartile (Lowest Nursing)
-9.6%
2nd Quartile
-1.0%
3rd Quartile
+6.2%
4th Quartile (Highest Nursing)
+17.3%
Ownership %
For- Profit
-0.8%
Government Owned
+2.3%
Non- Profit
+2.1%
Location %
Rural
+3.8%
Urban
-0.6%

27. Leveraging Technology
Contact your EMR and ask what they are doing to prepare
What new functionality/reporting will be made available?
When will these new features be released for testing?
Will your current workflows still be viable after EMR updates made?
Documentation Management
Facilitate compilation, storage, and review of referral documents
Streamline start of care workflow
Allow for documentation to be analyzed based on specific categories (i.e. referral source)
Orders Tracking
Maximize use of e-fax or electronic communication
Establish workflow for minimizing turnaround time on signed physician orders
Eliminate delays in checking signed orders into EMR

28. Questions?

29. Thank You! Brian Harris PointClickCare Home Care
BlackTree Healthcare Consulting
Consulting Director
(610) ext. 732
blacktreehealthcareconsulting.com l
PointClickCare Home Care
1 (800) Toll Free