Is When Your Agency Codes Important?
RCD and PDGM Commonalities
Review choice (RCD) is going strong in Illinois and Ohio. It’s due to start in Texas in March 2020 and North Carolina and Florida in May 2020. These agencies are also preparing, like the rest of the country, for PDGM starting January 1, 2020. Agencies in Texas and Florida and North Carolina are expected to choose their pre-claim option just as those in Illinois and Ohio did. Choosing “pre-claim” is the only option that allows correction and re-submission of OASIS without going to the appeals process.
Pre-claim submission will also go hand and hand with the requirements of PDGM. Agency’s engaged in a rapid cycle referral, assessment, and submission methodology will have close parallels to the cycles required to succeed in PDGM.
Nothing New – only faster!
CMS will not require any new paperwork for pre-claim submission, or PDGM for that matter. RCD does require specific documentation to establish homebound eligibility, medical necessity, and that the face-to-face encounter meet CMS regulatory requirements.
Review Choice and PDGM are both about having all the necessary documentation and diagnosis codes to substantiate your claims.
We recommend all agencies, not just those in Texas, North Carolina and Florida examine their Quality Assurance processes. Agencies who can complete OASIS, ICD-10 coding, and the POC in the shortest amount of time while upholding accuracy, will maintain cash flow in RCD and PDGM.
We can help
Creating single cycle correction Quality Assurance Systems is what we do. Click the link below and we’ll show you how to reduce your days to RAP from the industry average of 12, down to 2 To 3!!
HHVBP and PDGM mimic the restructuring hospitals went through in the acute care reforms when “fill the beds” turned into “empty the beds” almost overnight. This practice continues without fail almost twenty years later. Home health is now seeing high volume, large census, low value care models being replaced with high Acuity, outcomes driven, rapid cycle care.