PDGM 101

All About Oasis

100

Time points that an Oasis needs to be done.

What is SOC, RC, ROC , Transfer, Change in condition, D/C

200

Number of possible case-mix adjusted payment groups PDGM

What is 432?

300

 Factors that  limit Oasis excellence.

What are: Unclear Understanding of Oasis Purpose and Importance

•Lack of Foundational Education

•Inaccurate Interpretation of Oasis Items and Responses

Incomplete Assessment Data Collection

Assessment Findings not Being Consistently used

Limited Evaluation of OASIS Data Collection Competency in the Home?

400

2 M items that will now be considered under PDGM functional impairment score that were not considered under PPS.

What are M 1800 (Grooming) and M1033 (Risk for hospitalization?

500

8 M Items that determine functional impairment level.

What are M1800 Grooming, M1810 Upper body dressing, M1820 Lower body dressing, M1830 Bathing, M1840 Toilet Transferring, M1850 Transferring, M1860 Ambulation, M1033 Risk for hospitalization?

PDGM

100

_{Number of days  in the billing cycle under PDGM.}

What is 30 days?

200

• In PPS, two 60 day episodes are considered Early.  Looking for the time period considered early in PDGM.

What is the first 30 days only?

300

  CMS has assumed that home health agencies will make behavioral adjustments to make up for money losses.  Behaviors they are looking for.

What is Upcoding

Controlling LUPA's with unnecessary visits added Adding more co-morbidities that pair for a higher reimbursement

400

• The percentage CMS modified reimbursement to account for anticipated HHA behavioral changes.

What is Added an 8.1% reduction

500

The 5 factors used /considered to calculate payment (HHGM) with PDGM.

What are 

• Community vs Institutional, Early vs. Late, Clinical grouping, Functional level, Co Morbidity Adjustments?

600

The agency can influence the receipt of  appropriate payment for service regarding the following items

• Community vs Institutional, Early vs. Late, Clinical grouping, Functional level, Co Morbidity Adjustments

• What are Accurate and timely coding from good F2F /MD documentation, accurate and timely Oasis data collection by clinicians, managing utilization of resources by CLM’s?

700

•  PDGM affects LUPA Rates and for this period of time.

• What is Variable LUPA rates per diagnostic category for each 30 day period

Coding 101

100

• Number of sub groups in the Clinical Grouping.

What is 12?

200

 Coding adjustments under PDGM happen at these time frames.

• When is at ROC, RC or change in patient condition within last 5 days of first 30 day period?

300

The most important reason for accurate coding of co-morbidities.

What is Co morbidity adjustments can increase payment by up to 20%?

400

• The number of  Comorbidity Adjustment per period.

• What is you can have only one adjustment, either one high or one low, whichever is greater.

500

The 12 clinical groupings under PDGM (100 points for each 1 you can name)

What are Neuro Rehab, wounds, Complex nursing interventions, MS Rehab, Behavioral Health, MMTA-other, MMTA-Surgical Aftercare, MMTA- Cardiac Circulatory, MMTA- Endocrine, MMTA-GI-GU, MMTA infectious disease, MMTA-Respiratory?

General Knowledge

100

The initial certification for HHC is valid for:

What is one 60 day period of care

200

The POC/485 generated during created at these time points under PPS and PDGM.

What is SOC and R/C?

No changes to this under PDGM

300

 The number of days in the billing cycle under PPS.

What is 60 days?

400

 PPS  LUPA threshold.

What is 5?

500

The most significant agency focus in providing cost effective quality care.

What is 

• Managing utilization of resources and level of care

Misc

100

 PDGM affect on PEP's

What is changes to every 30 day period?

200

% PPS pays Raps.

What is 50-60%

300

Rap payment % under PDGM in 2020 and 2021

What is 20% and none?

400

Hospitalization affect outcome scores under PDGM

What is Reduces score by 36% if includes ED visit?

500

Keys to Success For Hospital & Home Health under PDGM

What are :

Coding and accurate patient data for reimbursement

Timeliness of process

F2F accuracy