Home health providers struggle to get physicians on board with shorter timeframes, more specific diagnoses
While the Covid-19 public health emergency stole the spotlight, home health providers have quietly struggled with another headache in 2020.
Medicare's new Patient-Driven Groupings Model (PDGM) ushered in shorter timeframes for collecting physician signatures and much stricter primary diagnosis requirements.
Some of the diagnoses most commonly occurring among home health patients -- such as symptom codes used for general weakness or gait abnormalities -- are no longer allowed as primary, requiring physicians to identify underlying medical conditions or diseases.
In states undergoing the Review Choice Demonstration, a Medicare initiative to detect fraud, agencies are also held accountable for specific physician documentation to establish medical necessity for skilled services. Reviewers carefully scrutinize referrals, physician orders and plans of care, and for agencies enrolled in the pre-claim review option, affirmation is required before agencies can submit their claims.
The what, why and how
It's up to home health providers to effectively communicate the what, why and how of all these changes to physicians, and elicit needed cooperation. "Some agencies have had a little more success than others in explaining new requirements to physicians," said J'non Griffin, President of Home Health Solutions, a Simione Coding Company. Often, success comes down to sheer persistence in communication, according to Griffin. "As with any successful messaging, the key is in keeping it simple for busy physicians to hear and understand -- and repeating it often," she said. Rule of 7 In explaining how to effectively communicate changes to physicians, Griffin often refers to the "Rule of 7," a marketing adage claiming that it may take as many as seven efforts to convey information to a targeted audience before the audience acts on information presented. "So, when you're frustrated because you're not seeing the results you'd like from attempts to communicate new requirements to physicians, it make take a few more attempts," she said. "Keep trying, and keep the message as simple as possible." Meetings (either in-person or via Zoom, Skype and other platforms), phone calls, letters and brochures can be effective tools for the process of communicating the need for specificity and faster turnaround times to physicians, according to Griffin. Major distractions Staying on track with the message hasn't been easy for home health agencies in 2020. Problems in understanding PDGM changes have been exacerbated by Covid-19, as home health providers scrambled to stay abreast of a flurry of regulations waivers issued by the Centers for Medicare and Medicaid Services (CMS).
Back to business
Although the Covid-19 public health emergency remains in effect, and waivers still apply, CMS has returned to business as usual on several fronts, including last month's resumption of the Review Choice Demonstration and medical reviews.
Florida and North Carolina are expected to join RCD during a phased-in implementation over the next six months, allowing agencies in those states to accelerate their participation as they feel comfortable.
"This means Florida and North Carolina do need to be participating -- at least to some extent," Griffin said. "And they really do need to be talking to physicians right now about the new requirements. Having that communication with physicians is going to be integral to a successful implementation."
Agencies in Texas, where RCD was paused shortly after it began, also need to continue the process of explaining changes to physicians as the demonstration resumes, Griffin said.
And even in Ohio and Illinois, where the demonstration has been going on longer, the discussion with physicians should be an ongoing process.
Need help talking to physicians?
If you're not sure how to talk to your physician about stricter requirements under RCD, Home Health Solutions offers products to help. A Power Point slide presentation titled "The Physician's Role" can be customized with your agency's logo and used in meetings to explain changes to physicians.
The slide presentation covers:
- A brief overview of RCD - How the pre-claim option creates a need for speed - What makes a referral complete - What's needed for a valid F2F - 4 questions physician documentation must answer to establish medical necessity - Brief overview of PDGM - The need for specificity in the principal diagnosis How to buy Two versions of "The Physician's Role" are sold in The Solutions Shop, the online store on the HHS web site. One version offers the Power Point slides only, and a second version pairs the slides with a brochure template covering many of the same points. The brochure can be printed out, folded and left with physicians and their office staff to reinforce many of the points made during the slide presentation. View the product here.