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Denials and Charting in a PDGM, RCD, and PHE World

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Date Published

December 1, 2020

Publisher

Ohio Health Care Association

Questions

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Summary

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.

Objectives

  • 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
Who should attend?

  • Administrators/Managers
  • Clinical Supervisors/Managers
  • Directors of Nursing
  • QA/QI Staff

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Presenters

Joe Osentoski
Author; Clinical Quality Assurance Specialist

Joe Osentoski, BAS, RN-BC has 25+ years in home health and hospice specializing in clinical quality assurance and regulatory... Read More

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Program Titles and Supporting Materials

This program contains the following components:

Video Presentation
Slide deck copy
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Credit

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How to Attend

Join the self-paced program from your office, home, or hotel room using a computer and high speed internet connection. You may start and stop the program at your convenience, continue where you left off, and review supporting materials as often as you like. Please note: Internet Explorer is no longer a supported browser. We recommend using Google Chrome, Mozilla Firefox or Safari for best results.

Technical Requirements
You may access this course on a computer or mobile device with high speed internet (iPhones require iOS 10 or higher). Recommended browsers are Google Chrome or Mozilla Firefox.

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