How Home Health Rebasing Affects Case Mix: Changes to Home Health’s Clinical Care - On-Demand
Thursday, April 23, 2015
Joan L. Usher, BS, RHIA, COS-C, ACE, AHIMA-Approved ICD-10-CM Trainer
It’s easy to be confused by adjustments to case mix. Home health is looking at many changes as a result of rebasing—in the PPS final rule, CMS projects a $60 million net decrease in payments to home health agencies in 2015.
Understanding what these changes mean to your agency, in actual cost, will empower you to continue to provide care with confidence. Join home health expert Joan L. Usher, BS, RHIA, COS-C, ACE, AHIMA-Approved ICD-10-CM Trainer, to review the regulations and what they mean for you.
At the conclusion of this program, participants will be able to:
- Describe what diagnosis are affected by case mix changes
- Identify the changes to the 19 M questions that affect reimbursement
- Compare reimbursement for 2014 and 2015 after rebasing
- Apply the changes to Medicare coverage for ongoing insulin administration
I. Variables changed in the case mix effective January 1, 2015
a. Common diagnoses that were affected by the change
II. Diagnostic categories in which points were given for case mix that no longer provide case mix reimbursement
a. Major categories, including blindness, pulmonary, behavioral health, and dementia
b. Categories that now have limited case mix points
c. Other clinical M questions that lost case mix points
III. Case mix thresholds and how CMS recalibrated the case-mix weights in the final rule
a. Tables of comparisons for reimbursement for common home health diagnoses
IV. Insulin administration under Medicare in 2015
Six common diagnoses reimbursement comparison tables from 2014 and for 2015.
Who Should Participate
- Administrators and Directors
- Staff educators
- Billing leadership
- Quality department
- Homecare nurses
Meet the Speaker
Joan L. Usher, BS, RHIA, COS-C, ACE, AHIMA-Approved ICD-10-CM Trainer, is president of JLU Health Record Systems in Pembroke, Massachusetts. Usher has more than 27 years’ experience as a consultant and is a nationally recognized expert in the field of ICD-9 & ICD-10-CM coding and health information management (HIM). She has taught ICD coding in home health for 17 years and has educated more than 15,000 people nationwide. Usher is a past president of the Massachusetts Health Information Management Association. Under her leadership, Massachusetts received four national awards from AHIMA in continuing education programs, support for accredited HIM education, legislative advocacy, and electronic communications.
Usher is one of Beacon Institute’s experts for our Ask-the-Expert membership benefits. She also provides a monthly ICD-10 coding column for our Homecare DIRECTION newsletter and speaks during many of Beacon Health’s successful webcast series. She has contributed to numerous national publications and is the author of HCPro’s ICD-9 Coding for Home Health: A Guide to Medical Necessity and Payment, ICD-10 Coding for Home Health: A Guide to Medical Necessity and Payment, and ICD-10 Essentials for Homecare: Your Guide to Preparation and Implementation.
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