Claims containing primary diagnoses that do not fall into one of the 12 PDGM clinical groups may be denied by CMS or sent back to the agency with a “Return to Provider” (RTP) remark. Such primary diagnoses are referred to as “Questionable Encounters” (QEs). QE… Read More »Tips to Avoid the Use of Questionable Encounter Codes
According to Medicare Home Health Conditions of Participation (CoP), each patient must undergo a patient-specific comprehensive assessment, provided by the home health agency. This assessment should incorporate the latest OASIS items, following their language and groupings. These requirements for the comprehensive assessment and OASIS data… Read More »When Is OASIS Data Collected as Part of the Comprehensive Assessment?
Major changes were introduced in OASIS-E last year, which included several new standardized items. Ensuring accurate responses to these new OASIS items is crucial for home health agencies, given the adjustments involved. Apart from assessing the quality of patient care provided and identifying areas for… Read More »2 Common Pitfalls in Scoring New OASIS-E Items
Home health agencies typically assess and monitor patients’ functional status in order to create personalized care plans, ensure accurate reimbursements, and provide data for quality reporting. Currently, agencies utilize OASIS items from Section G, the M1800s, to calculate reimbursement, star ratings, and Value-Based Purchasing (VBP)… Read More »Shifting from G to GG items in QRP and VBP
The two Transfer of Health (TOH) process measures are new additions to the Home Health Quality Reporting Program (HH QRP). They will be publicly reported on Care Compare starting in January 2025, as outlined in the CY2024 Home Health Final Rule. The initial data for… Read More »New Transfer of Health (TOH) Measures, Explained
A report by the Office of Inspector General (OIG) last year revealed that home health agencies failed to properly document and report a significant number of fall incidents with major injuries among Medicare patients. Stricter scrutiny is expected for HHAs for timely completion of OASIS… Read More »Tips for Documenting Falls in OASIS Items J1800 and J1900
The latest version of the Interim Performance Report (IPR) for HHVBP is set to be available in iQIES by end of January 2024. It allows agencies to evaluate and monitor their quality measure performance compared to peers in their cohort. The January 2024 IPR will… Read More »Reviewing the January 2024 IPR for HHVBP
The Draft version of the OASIS-E1 Instrument has been released by CMS giving home health agencies an early look at the changes to the OASIS taking effect January 1, 2025 The OASIS document requires updating to accommodate some changes related to policy, including the end… Read More »CMS Releases Draft OASIS-E1 Instrument
The demand for home and community-based care will grow due to aging baby boomers, elderly preference to age at home, and healthcare cost reduction pressures. Despite growth opportunities, home healthcare providers will face headwinds in 2024, including a persistent labor shortage, heightened competition, reimbursement cuts,… Read More »Industry Trends Shaping Home Health in 2024
The CY 2024 Home Health Final Payment Rule introduces a wave of changes, including updates on the comorbidity adjustments. The final rule reads: “only those subgroups of diagnoses that represent more than 0.1 percent of periods of care and that have at least as high… Read More »Comorbidity Adjustment Changes in 2024
