PDGM's 30-day timeframe

New billing cycle will force home care to get its act together: orders signed, POC completed – and one thing no one wants to talk about.

Billing processes at the nation’s home care agencies are expected to become more streamlined in 2020, as providers scramble to meet new Patient-Driven Groupings Model (PDGM) requirements for expedited signatures and information collection.

Medicare’s payment overhaul cuts the traditional billing cycle in half, imposing a new 30-day limitation for completion of a patient’s plan of care with physician signature and signed orders for all treatment and services.

But in conference rooms and classrooms across the nation, wherever home care providers gather to learn more about what will be expected of them under the new payment model, there’s one aspect no one wants to talk about.

It’s the need for home care agencies to cut ties with referral sources which fail to meet the new 30-day timeframe.

“This is the part no one likes to hear,“ said Apryl Swafford, Clinical Director at Home Health Solutions LLC. She has been traveling the country this spring to provide PDGM training to agencies and at trade conferences.

“Everybody is eager to learn how to prepare their referral sources for the new timeframe ahead,” Apryl said. “Agencies understand how important it is to get physicians on board with expedited timelines under PDGM. They want to know how to best get the full attention of referral sources. They want to talk about the best ways to present these new requirements to physicians with a sense of urgency and importance. And they especially want to talk about how to get reluctant and uninterested physicians to buy into the need to expedite things.”

What agencies don’t want to hear, according to Apryl, is what has to happen when referral sources can’t be persuaded.

“If an agency has a doctor who routinely signs orders more than 30 days into the episode of care, or delays signing the plan of care, the agency is going to have to look at no longer using that doctor,” Apryl said. “The agency is not going to get paid if they continue to use that doctor.”

Cutting ties

Under PDGM, any treatment or service provided within the first 30 days of care will require a signed order from the physician before the claim for the first 30 days can be filed.

The plan of care will need to be signed and submitted within the 30-day window as well.

“Working with a doctor who is routinely taking longer than 30 days is going to put agencies behind the 8 ball from the start,” Apryl said. “Agencies need to be monitoring their processes right now to determine whether everything is getting signed in a timely fashion – and if not, agencies need to identify who is slowing down the process and why, and take steps to rectify the situation with coaching.” 5 tips for providers

Apryl offers these tips to home care providers as they look to tighten timelines in preparation for PDGM:

1. Evaluate the agency’s current process for tracing signature compliance. Is there a systematic process in place with specific timeframes? If not, this is the time to create one. Address in writing how and when the agency will fax, call or visit physician offices to obtain important signatures.

2. Determine who is responsible. Make certain the agency has identified someone to oversee and take responsibility for this important process, including standardized follow-ups and compliance checks at specific times within the 30 day billing period.

3. Begin educating referral sources immediately. Not sure how to begin these important conversations about the changes ahead with your referral sources? (Check out our $19.99 “Tools for Tough Talk” package, a brochure template which can be printed out in the quantity your agency needs. It is designed to be taken to physician offices to present important information in an easy-to-read format with bulleted points explaining what PDGM is and the importance of new timelines.)

4. Educate the agency staff as well. Every person on staff needs to understand the ins and outs of the new payment model and why it is crucial to make and enforce operational changes it requires. (Can’t travel to conferences or PDGM classes? We can create a PDGM webinar for your staff. Contact us for more information.)

5. Agencies not already using an electronic portal to expedite communication with referral sources should consider doing so.

One-day seminar offers more

Apryl will join Home Health Solutions Owner and President J’non Griffin in Chicago June 6 for a one-day, $199 seminar designed to provide PDGM training to agencies on how to work with referral sources, implement new billing processes and set up new marketing strategies designed to sidestep PDGM-related issues. They will be joined by Richard Dixon, President and CEO of Dixon Healthcare Solutions, who will address billing processes, changes in Requests for Anticipated payment (RAPs ) and other important financial issues under PDGM. For more information on the seminar, click here.

(Be sure to read our previous blog post on how PDGM's new 30-day billing cycles will impact OASIS assessments and the face-to-face encounter.)