The Centers for Medicare and Medicaid Services (CMS) announced the extension of the Review Choice Demonstration (RCD) for five more years effective June 1, 2024. RCD will continue in the current demonstration states of Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma. Removal of Choice… Read More »CMS Extends Review Choice Demonstration (RCD) for 5 More Years
It is undeniable that the M1800s and GG items are crucial components of the OASIS impacting quality outcome measures and reimbursements. However, agencies should not overlook the importance of other OASIS items, which provide essential data for risk adjustment beyond mere documentation compliance. Risk adjustment… Read More »Beyond GG and M1800: Crucial OASIS Items for Risk Adjustment
On May 3, CMS released two vital draft OASIS documents: the Draft OASIS-E1 Guidance Manual and the Draft Time Point Versions of the OASIS-E1 Instrument. Upon release of the final versions, these will become effective on January 1, 2025. We have outlined the notable changes… Read More »Out Now: OASIS-E1 Draft Guidance Manual and Time Point Versions
Documentation is an integral part of healthcare, demanding nearly the same time and effort as direct patient care. This is particularly true in home health, where compliance standards and documentation guidelines have progressively become stricter and more intricate. Consequently, this has become a significant challenge… Read More »4 Ways to Ease Documentation Work of Clinicians
The home health industry is experiencing a recent surge in medical reviews/audits, posing challenges for many home health agencies. Most audits that home health agencies are receiving through Medicare Administrative Contractors (MACs) are Targeted Probe and Educate (TPE) audits, which were reinstated in September 2021… Read More »Navigating the Surge in TPE and Other Audits
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
