PDGM Fit List – 4 Tips for a Healthy Revenue Cycle
PDGM will rely on accurate data from all areas: from intake to final claim. Revenue cycle management has never been more important. Luckily, QIRT has created a PDGM Fit List to help agencies examine their current practices and prepare for change. (Find Tip #1 here.)
Tip #2 Ensure Accuracy and Timeliness of Data
Most important to remember is that it all starts at intake. Accurate data must be collected here to prevent billing/revenue issues. With the onset of PDGM, agencies must recognize the significance of Early versus Late and Community versus Institutional. Therefore, coding is even more important because it is 2 parts of HHRG (Clinical Grouping and Co-morbidities) and up to 25 diagnosis codes can be entered on the claim.
Accuracy Begins at Intake
The claim and POC must match. Accuracy is a key component of success in PDGM – everything must match. For instance, if you have received the face-to-face at intake, it must be complete, signed, dated and contain documentation that the F2F information was given to the MD to be placed into the patient medical record. Certainly, the need for home care must match the POC primary diagnosis on the claim. Here are some tips we recommend to maintain accuracy:
- Begin enforcing the use of an intake query list at intake to assist staff to ask the right questions
- Liaisons should take intake to its fullest extent
- Clerical staff can be used in intake with clinical taking a role for review only
- Staff someone with coding expertise (not clinical) in intake; they will know the questions to ask and what documentation to obtain
RAP Impact in PDGM
Agencies certified after 1/1/2019 will not submit a RAP but will submit a “Notice of Admission” that this is their patient. As such, there may be a potential phase-out of RAPs in the future. For now, however, RAP auto-cancel rules still apply, so if agencies bill a RAP but no final claim within 90 days of the paid RAP or end of the episode (whichever is later) there is RAP recoupment. After a certain number of these in a quarter, CMS will put an agency on RAP suppression.
Some RAP Stats
- CMS estimates the median RAP time is 12 days.
- CMS Data 2017 – 5% of RAPS are submitted after day 60 = 281,000 RAPS in 2017
- No data on RAPS submitted on day 31, 45, 55, etc. – agencies may want to get that information from their system for 2018
Billing Strategies for PDGM
- Tighten down workflow processes and set higher “bars” for outcomes
- F2F complete, correct, signed, and dated – 98% at SOC
- Coding and OASIS review completed – 95% at 2 days
- Orders completed and sent out and returned signed and dated – 95% received within 30 days
- OASIS completed and exported to the repository – 98% within 7 days
- Leverage your QAPI plan to do meaningful PIPs for billing/collections
- Bill daily
- Set productivity and cash goals for each staff member
- Review each job description and ask yourself if technology can help
Outsource Your Billing with QIRT Financial
Need more help?
Our QIRT experts have created PDGM tools to assist with your home care agency’s preparations. Be sure to make good use of this QIRT advantage…on us! PPS to PDGM Crosswalk
Tune in again soon for QIRT’s PDGM Financial Fit List: Tip #3.