Home Health Articles and Information


Nov 11, 2019 3:00:00 PM / by Kristi Bajer, BSN, RN, COS-C

Marketing / Community Liaisons Take a Vital Role in PDGM

Being an extrovert and having the ability to deliver donuts was once the main criteria for marketing in home care.  Those days are long gone.

Home health marketers must know the difference between a suggestion and a referral.

 A patient name and an order to evaluate and treat is no longer a referral!

A valid referral is considered to have been received when the agency has received adequate information about a patient, including name, address/contact info, and diagnosis and/or general home care need.

- OASIS D guidance manual, Chapter 3

Thriving in PDGM with its 30-day payment periods will require a much more rapid cycle admission process. This starts with “a good referral”.

A “good referral” includes;

  • A face to face with primary ICD-10 diagnosis coding, medical necessity, and home bound status
  • Remember this can be part of the H&P documentation, it does not have to be on a separate form
  • H&P from the face to face visit, which should include the primary diagnosis or reason for home health AND show medical necessity related to that diagnosis
  • The H&P must show a medical need. If the visit note shows the patient is “stable” or “WNL” for the same reason as home health is ordered, the claim will not stand up to audit

Marketing should be on the front lines of your agency’s PDGM preparation. Providing education to referral sources about PDGM documentation requirements now, will ensure your admissions don’t slow down on January 1st.

Additionally, marketers should be carefully vetting todays referrals and asking for any additional documentation before they leave the referral sources’ office. They should be reaching out to referral sources who send referrals to the office, not depending on intake to call and fax days later and beg for needed patient information.

Starting as soon as possible, we suggest agencies should require all needed documentation up front.  This will ensure your patients are taken care of, your billing is timely, and your agency thrives in PDGM.

Tags: PDGM, RCD, Co-morbidity, Home Health, ICD-10 Coding

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.