PDGM: Patient-Driven Groupings Model for Home Health

1. PDGM:Patient-Driven Groupings Model for Home Health Minimizing Impact for Patients and Providers Date | Presenter Information (16 pt)

2. What’s Happening? • PDGM: CMS changes reimbursement model for all home health agencies; Other payors may follow suit • Go live: January 1, 2020 (Advocate Aurora soft-launch scheduled for November 1, 2019) • Biggest reimbursement change for home health in 20 years

3. What’s Happening? • With a focus on value, CMS is aligning payment and patient care • No change to patient Medicare benefit or eligibility, or our focus on quality patient care and top health outcomes • New: “Code the Causes not Symptoms” and “How Sick the Patient is” • New: a list of “Unacceptable Diagnosis Codes” that will need more specific admitting diagnosis codes to qualify for home care

4. Unacceptable Diagnosis Codes

5. National Top 25 UDCs

6. Why Should I care? • Timely acceptance of patients into any home health agency • Rework for you and your staff • Potential loss of revenue/shared savings • System, IL Bundles, MSSP programs • Significant change to the industry • Some Home Health agencies will close • More specific diagnosis codes leads to better patient care

7. What are We Doing? • Changing internal home health processes from intake to billing to accommodate new reimbursement model • Communicating PDGM changes system-wide • Educating our liaisons, intake and marketing representativeson appropriate admitting diagnoses • Actively reviewing admitting diagnoses • November 1, 2019, begin working with referring physicians and care management for alternative admitting diagnoses and more specific documentation

8. What do We Need? • Be familiar with Unacceptable Diagnosis Codes • Code the Causes leading to the home health need as detailed as possible for the medical diagnoses and all comorbidities • For IL non-Epic users, use the F2F Power Note in CareConnection • Refer in-system to maintain revenue/shared savings, patient coordination and quality of care • Competitors will want hospital and SNF referrals

9. What do We Need? • Respond quickly for requests for more specific information • Sign the Plan of Care right away! • Home Health billing cycle cut from 60 days to 30 days • If Plan of Care is unsigned • Orders faxed/Inbasket messages starting Day 3 • If no response, then phone calls and visits to the provider’s office if no response • Discharge of the patient without valid orders • Escalate to system leadership

10. Remember! • Code the Causes! • Sign the Plan right away! • Refer in system!

11. Questions? • Contact the liaison/marketing representative at your site for help or call us at: • IL 1-800-564-2025 • WI 1-800-862-2201 • Ask for the PDGM team