Denials and Charting in a PDGM, RCD, and PHE World
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December 1, 2020
Ohio Health Care Association
While 2020 began with the change to the Patient-Driven Groupings Model (PDGM) for reimbursement, the continuing Covid-19 Public Health Emergency (PHE) has put a different spin on dealing with the PDGM implementation.
The August 2020 resumption of medical review activities by Medicare contractors while Review Choice Demonstration continues both have effects on how the agency charting is viewed by Medicare contractors. Thus, compliant charting is more important than ever to minimize payment delays in this challenging home health environment.
This presentation walks attendees through the PDGM payment changes from the prior Prospective Payment System (PPS) in relation to the relevant home health coverage requirements. How these changes affect denials issued is addressed. Charting improvement suggestions for compliant charting and RCD compliance are presented. Finally, the PHE waivers applicable to home health are also covered including suggestions on how to address these in a post-PHE transition plan for documentation.
- Understanding of the PDGM payment model and its relation to claim denials
- Documentation needs within PDGM l to lower chance of triggering a review or denials.
- Best charting practices for compliance within RCD
- PHE waivers for home health, how to implement them during the PHE and transition after the PHE has ended
- Clinical Supervisors/Managers
- Directors of Nursing
- QA/QI Staff
Program Titles and Supporting Materials
This program contains the following components:
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