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ICD-10 Transition Comes Early for Home Health

Tricia A. Twombly, BSN, RN, HCS-D, HCS-O, COS-C, CHCE

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Electronic (digital download/no shipping)

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Description:

The home health industry’s reimbursement cycle is unique in the health care continuum. In-patient settings will use the date of discharge as their transition compliance date. Other healthcare entities will use the date of service as their ICD-10 conversion date. Homecare, on the other hand, is reimbursed per a 60 day episode, corresponding to multiple dates, not one. This means, the transition to ICD-10-CM for home health, is August 3, 2015, not October 1st. Home health is required to submit a request for anticipated payment (RAP) as soon as possible after care begins in order to assure being established as the primary HHA for the beneficiary. This request for payment includes the patient’s diagnosis codes. At the end of the 60-day period, agencies are required to submit the end of episode claim (EOE), which also includes the patient’s diagnoses. A patient admitted on August 3, 2014 will have the RAP submitted with ICD-9-CM diagnosis codes but the EOE claim will be submitted on or after October 1, 2014, with ICD-10 diagnosis codes. In order to assure an uninterrupted billing cycle, the RAP must be dual coded with both ICD-9 and ICD-10 codes, transmitting only the ICD-9 codes. The EOE claim will transmit only the ICD-10 codes, in essence, making home health’s transition date, nine weeks earlier than the rest of the country. To complicate the transition further, the reimbursement is calculated from a HHRG score, much like a hospital DRG score. Part of the HHRG score is derived from diagnosis codes. The HHRG score will be calculated for the RAP submission with ICD-9 codes, as part of the equation. However, the patient who’s episode spans the transition date will have their EOE claim submitted with ICD-10 diagnosis codes. Medicare claims processing regulations require the codes on the RAP to match the codes on the EOE, which will not be possible during the ICD-10 transition. The home health industry is faced with unique challenges leading up to the ICD-10 transition. The compliance date arrives earlier for homecare than any other healthcare entity and the compensation process will require an in-depth understanding by home health coding and billing specialists. The industry as a whole, must take advantage of home health specific educational resources, not only for transition date readiness, but to successfully navigate the reimbursement cycle. In this session attendees will learn: • Transition compliance date challenges unique to home health • Differences in the home health reimbursement cycle • Transition reimbursement challenges unique to home health • Industry transition problem solving and solutions The home health industry’s reimbursement cycle is unique in the health care continuum. In-patient settings will use the date of discharge as their transition compliance date. Other healthcare entities will use the date of service as their ICD-10 conversion date. Homecare, on the other hand, is reimbursed per a 60 day episode, corresponding to multiple dates, not one. This means, the transition to ICD-10-CM for home health, is August 3, 2014, not October 1st. Claims will require mandatory dual coding beginning nine weeks prior to the October transition date with ICD-9 codes used for a portion of the bill and ICD-10 codes listed on the final claim. The home health industry is faced with unique challenges leading up to the ICD-10 transition. The compliance date arrives earlier for homecare than any other healthcare entity and the compensation process will require an in-depth understanding by home health coding and billing specialists. Industry problem solving and reimbursement solutions will be discussed and analyzed in this presentation. I. Transition compliance date challenges unique to home health A. Multiple dates govern home health billing cycle B. Beginning episode date vs. assessment completion date vs. end of episode date II. Differences in the home health reimbursement cycle A. 60 day episode B. RAP and EOE requirements III. Transition reimbursement challenges unique to home health A. Episodes spanning October 1, 2014 B. Mandatory dual coding nine weeks prior to transition date IV. Industry transition problem solving and solutions A. Final claim HHRG calculations/CMS PPS Grouper calculations B. Vendor testing Attendees will understand the unique home health transition challenges including why homecare will transition nine weeks earlier than the rest of the nation and the distinctive reimbursement cycle that dictates mandatory dual coding beginning August 3, 2014.

Product Details:

Product ID: WEB-108
Publication Year: 2015