Home health providers are receiving a growing number of patients with more complex medical needs, which requires more specialized care and attention. Overall, patients with higher acuity levels need additional services after leaving the hospital, which makes it more challenging for home health providers to… Read More »Home Health Adapts to Increasingly Complex Patient Cases
The latest version of the Performance and Improvement Progress Report (PIPR) was released in April 2023, accessible through the iQIES system, your usual source for CASPER reports. PIPRs show your current percentile ranking for each outcome measure when compared to agencies nationwide that belong to… Read More »New PIPR is Out: What’s In It for You?
Diagnosis queries have become an increasingly vital process to ensure adequate documentation and accurate coding. However, it is often challenging to obtain timely responses from physicians regarding queries. For instance, the demanding schedules of physicians/providers make it difficult to find an appropriate time for discussions.… Read More »Coding Query Tips and Examples
Sometimes, the ICD-10-CM guidelines demand that a particular medical condition be reported using multiple diagnosis codes. This practice is known as “mandatory multiple coding,” “dual classification,” “dual coding,” or “mandatory dual coding.” A specific instance of this mandatory dual coding is included in the “etiology/manifestation… Read More »Reviewing Etiology and Manifestation Coding
Despite no COVID-19 surge this winter, rejection rates for home health referrals have risen to an all-time high of 76%. The increase is due to staffing shortages, reimbursement setbacks, and the fact that patients admitted to home health care tend to have higher acuity. This… Read More »A Look into the Rising Referral Rejections in Home Health
The Centers for Medicare & Medicaid Services (CMS) has recently published a new set of quarterly OASIS Q&As. It includes questions received by the CMS help desks from the first quarter of this year, following the implementation of the new OASIS-E. These Q&As offer valuable… Read More »Eyes Here: April 2023 OASIS-E Q&As
The new OASIS-E emphasizes assessing patients’ cognitive function. Section C provides detailed guidance for evaluating memory, communication skills, and decision-making. The manual also includes tools to identify delirium, such as the Brief Interview for Mental Status (BIMS), which assesses attention, recall, and orientation. This section… Read More »OASIS-E Challenges and Solutions: Section C and BIMS
Knowing the top claims denial reasons from Medicare Administrative Contractors (MACs) is helpful for home health agencies aiming to maintain financial stability and ensure timely reimbursement. By identifying and addressing the root causes of denials, providers can improve their billing and coding practices, optimize cash… Read More »Top Claims Denial Reasons from MACs
Assigning accurate medical codes involves having substantial documentation sources and meeting specific requirements based on the type of code. Certain code categories present unique documentation challenges that need to be addressed to support code assignments. Incomplete documentation with missing key information can lead to a… Read More »Spot Common Documentation Deficiencies in Specific Code Categories
Accurate and patient-specific coding is crucial to succeeding with the Patient-Driven Groupings Model (PDGM). Proper diagnosis coding ensures you receive the appropriate payment while addressing your patients’ healthcare needs. Submitting claims with coding errors can lead to the claim being returned to the agency for… Read More »Coding Reminders and Red Flags
