1) Preventing Revenue Loss
Start-up home health agencies are particularly vulnerable to billing errors that can cause you thousands of dollars in uncollectable revenue.
This webinar will teach you how to not fall into that trap! It’s called Start Smart with Home Health Billing – Learn how to bill right from the start.
You will learn how the bill Medicare correctly from the beginning and get paid right the first time. You will also learn how to bill private insurances which is important for all agencies whether you are Medicare certified, non-skilled, or a skilled agency that will not accept Medicare Patients.
This webinar has been seen by thousands of new home health agencies just like yours and is proven to help you not lose money.
Webinar HandoutsTip: Watch the video above first before moving on. It will make it easier to understand the next step: 2) Maximizing Your Revenue.
2) Maximizing Your Revenue
These tools are designed to help you better understand how your Medicare payments are calculated. By learning how Medicare comes up with your payment you’ll be able to generate the best payment.
As we mentioned in the video above, Medicare has created a formula that is based on the patient’s clinical characteristics and other patient information to place your 30 day period of care into a payment category.
This formula is comprised of 5 main categories that will determine your reimbursement. The categories are as follows:
- Admission Source
- Timing
- Clinical Grouping
- Functional Impairment Level
- Comorbidity Adjustment
The primary Dx will be very important in order to determine what payment group your claim will fall under. There are over 43,000+ primary Dx codes. Your primary diagnosis code MUST be on this list. If you do not use the primary Dx code from this list, your claim will not be processed.
PDGM ICD LookupIn the webinar, we talked about how important it is to add all secondary diagnosis codes that can affect the plan of care on the claim. This is important because some secondary Dx codes could potentially increase your payment by 20%.
Use this comorbidity lookup tool to determine if a specific comorbidity dx code falls into the Comorbidity subcategory chart below for CMS to consider a comorbidity adjustment that would increase your payment.
PDGM Comorbidity AdjustmentIn the webinar, we also went over what are Lupa adjusments and their importance to determine what the visit threshold will be in order to avoid a lesser payment when it’s clinically appropriate.
Use the PDGM Lupa Lookup Tool to determine what the visit threshold will be for any 30 day period of care.
PDGM Lupa Lookup Tool
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What data source was used: HH PPS Grouper Software HH PDGM v05.1.24 posted on 8/13/2024.
The use of this tool does not replace clinical judgment. Providers should use their professional expertise and discretion when determining appropriate codes, and sequencing of codes. ICD-10 codes and guidelines may change over time. Users should regularly consult the official ICD-10 resources to stay informed of any updates.
This tool is not intended for direct use in billing. Users must consult official billing guidelines and policies before submission. This tool is designed to align with current PDGM regulations. However, users are responsible for ensuring compliance with all applicable federal, state, and local laws.
The creators of this tool accept no liability for any errors or omissions in the information provided. Users are encouraged to seek professional advice when necessary.