HOME HEALTH:
Adapt To New Reimbursement Strategy With These 3 Tips
Published on Mon Oct 15, 2007
OASIS accuracy can make or break your agency in 2008
Home health agencies can't avoid the 2008 payment cuts, but they can minimize them using one basic tool--their OASIS assessments.
The 2008 prospective payment system revamps the mathematical calculation that determines the home health resource group and the episode payment. "This [new PPS payment plan] is a complicated beast," said Jeff Lewis, CEO of Baton Rouge, LA-based Lewis Inc.
And, yes, somebody has to know how to calculate these payments, but it's not your clinicians, Lewis told listeners in an educational session at the National Association for Home Care & Hospices' October annual conference in Denver. Clinicians just need to know how to provide the correct answer for each OASIS question--the answer that fits the patient, he said.
Studies show that too many OASIS assessments still are inaccurate or incomplete, Lewis said. "Agencies will be grossly underpaid in the 2008 payment plan if their assessments are incomplete," he warned. Look to your own agency's data to discover strategies to stay profitable under the payment cuts coming your way, he suggested.
Reimbursement under both the current and the new systems depends on the diagnosis codes and the OASIS questions that make up the clinical, financial and service components of the home health resource group. But the Centers for Medicare & Medicaid Services has changed each of these components in the new system.
Knowing what changes will affect your agency the most lets you focus on adapting to those changes first, Lewis said. Some tips:
1. Code all the diagnoses the patient has. Diagnosis coding skill will matter more than ever in 2008, but so will thoroughness. Agencies that meticulously code all the diagnoses can expect to receive diagnosis-based reimbursement in 20 percent more episodes than in 2007, Lewis found.
Good news: Most providers will get at least some improvement in diagnosis-based episode reimbursement next year, says Lewis. This is because more diagnoses receive case mix points in 2008. The better job you do using diagnosis codes to describe your patients, the more likely you are to receive the reimbursement you deserve.
Bad news: Agencies that got the most diagnosis-based payment in 2007 will be the biggest losers in 2008. Focusing only on coding the case mix orthopedic, neurological, diabetic and trauma diagnosis codes paid well in the past, but the payment is spread out over many more diagnoses next year, Lewis explained.
And even last year's top diagnoses pay less in 2008. Diagnoses that added the most reimbursement in 2007 added $950. The highest diagnosis-based added reimbursement in 2008 will be $550, he said.
Only codes in the first six diagnosis code positions in M0230 and M0240 "speak to CMS," Lewis said. CMS looks to these first six codes when considering [...]
