Home Health, News

Create a clinical documentation improvement program to achieve PDGM success

Strong documentation is key in home health, and implementation of the Patient-Driven Groupings Model (PDGM) will add a new level of urgency to improvement in this area, industry experts contend.

Coding will play a major role in how agencies are paid under PDGM, from determining the clinical group to whether a patient qualifies for a comorbidity adjustment. And quality documentation is key to proper coding.

Under PDGM, failure to identify an appropriate primary diagnosis could result in claims getting returned to provider, delayed payments or even denials if more appropriate coding cannot be identified.

“What are you going to do when 60% of your episodes get kicked back and you won’t get paid for it?” asks Brandi Whitemyer, an independent home health and hospice consultant based in Canton, Ohio.

Because PDGM will move to 30-day payment periods, agencies will have even less time to ensure all clinical documentation is complete in order to file the claim.

Establishing a clinical documentation improvement (CDI) program can help agencies address documentation issues now through a strategic, formal approach. Formal CDI programs are designed to get accurate, timely and complete information to facilitate efficient care delivery and appropriate coding. Achieving these goals can contribute to improving patient outcomes, protecting revenue and reducing risk for additional documentation requests (ADRs).

Concurrent documentation review, effective and compliant query processes and data analysis should be part of a successful program. These elements will be crucial to success under PDGM “because our diagnoses are just going to impact our payment so much more and in a shorter time,” Whitemyer says.