Home Health: Don’t Leave Good Money On The Table (Making the most out of PPS episodes)
As we all know, Medicare is cutting back and there are continued issues with Medicare-Advantage and other insurance plans. This means home health agencies need to do everything possible to get the maximum allowable from Prospective Payment System (PPS) episodes. However, when I review the financial practices of many of the home health agencies I consult with, I invariably find my clients are leaving good money on the table because of inadequate assessments and coding errors. These mistakes or inadvertent omissions score patients for less than they should be scored. Undercoding takes away valuable resources yet is a relatively easy issue to fix.
In my own work, helping clients realign for financial and organizational growth invariably involves some degree of education and training. Making certain your entire staff is well versed in proper assessment and coding practices is an extremely effective way to ensure cash flows. Using a professionally designed dashboard will further help to align reimbursements.
Another tried and true way to avoid undercoding is to implement ongoing education on the OASIS assessment. A very innovative Quality Improvement Manager I know developed an “MO of the Month” (which now has become the “M of the Month.”) Each month, she takes an element of the assessment that appears to be consistently mis-scored. She prints out the instructions on how to score that element and posts it everywhere in the organization, including on the inside of each bathroom stall door. It makes it very hard to miss. Her belief is that education should be fun as well as informative. This is an extremely cost-effective and successful way to sustain ongoing education. Since implementing this educational attention-grabber, the agency’s case weights have dramatically increased.
Answer accuracy in scoring the OASIS will always be a challenge. Making certain everyone is on the same page with how responses will be scored and making the learning process fun and sustained, allows you to maximize what you are truly entitled to under the PPS system.
Category: Education & Training, Ginny's Blog