Floral Park, NY – June 2019 PRlog QIRT, a home health and hospice coding, billing, and consulting company, collaborated with a PDGM Workgroup to bring concerns about the assignment of ICD-10 codes as primary for the purposes of placement in a clinical grouping, as well as when addressing other diagnosis-coding-related issues, to the attention of Centers for Medicare & Medicaid Services (CMS). On or after January 1, 2020, the payment system for home health agencies will be changing from the Home Health Prospective Payment System (HH PPS) to the Patient-Driven Groupings Model (PDGM), which will result in a significant workflow and process change that has raised concerns within the industry. The PDGM Workgroup’s letter is intended to ensure that the transition does not have a deleterious impact on home health agencies. [Read the letter in its entirety here.]
Corinne Kuypers-Denlinger, Vice President of Post-Acute Growth Strategies at QIRT, is the chair of the Workgroup working in conjunction with National Association of Home Care and Hospice (NAHC), the workgroup includes among its members nationally known home health coding and OASIS experts who are practitioners and have vast experience teaching coding conventions and guidelines, as well as official guidance governing OASIS completion. Also represented in the group are industry-leading home health financial analysts. Together, the workgroup members sent a letter to Director Hillary A. Loeffler, Division of Home Health & Hospice, CCPG at CMS. There has not yet been a reply.
“Drawing on my years of experience in the industry, I agree that it is appropriate to see the patient placed at the center of care. Value-based outcomes per agency will become clearly evident with PDGM,” explained Laura Page-Greifinger, President and CEO of QIRT. “Accurate coding to arrive at the primary diagnosis and co-morbidities of each individual patient is necessary to reflect the severity of the patient condition, reduce the number of claims being returned to providers, and to capture population health data based upon patient characteristics. The QIRT Team will continue to advise the industry to prepare ahead of time with best practices to accommodate the changes in functions of the agency that PDGM will bring. QIRT welcomes this challenge and will work tirelessly to help agencies prepare for and thrive in this new payment model.”
“Identifying the issues and compiling the evidentiary data for inclusion in the letter to CMS regarding ICD-10 coding issues related to the clinical groupings in PDGM was a true collaborative effort by industry stakeholders committed to ensuring that agencies experience the smoothest possible transition to PDGM,” added Corinne Kuypers-Denlinger. “The team of experts and the leadership of NAHC applaud CMS’ efforts to put the patient at the center of care, to improve outcomes and to preserve the Medicare fund for future beneficiaries. The PDGM Workgroup and NAHC will continue to convene throughout the transition and after to proactively identify issues and concerns and bring them to the attention of CMS.”
QIRT has been an active voice since PDGM was put forth by Medicare as the reimbursement model for home health agencies in 2020. The QIRT Team has participated in the NAHC PDGM Summits across the nation and has provided multiple seminars and webinars to prepare agencies for this sea change to workflow processes. QIRT is also working with NAHC leadership to design a page on NAHC’s website to house a “vendor-agnostic” list where agencies in need of assistance can access tools and support in advance of the transition. Vendors with specialties across the industry have been invited to contribute. The webpage in due to be live within a month.