Medicare’s 2020 PDGM Changes: The Effect on Healthcare Staffing
Providers, nurses and caregivers
Seamless orders management
Under the 2020 PDGM changes, all orders and care plans from the healthcare provider must be completed and signed before submitting the final claim for each billing period. In reality, this could be cumbersome, as a patient’s health status and, therefore, a healthcare provider’s orders can quickly change. Further, updating and verifying changes can mean playing email and phone tag to get them done. This works against the HHA’s goal to provide timely care.
To help HHAs manage the process efficiently, a mobile workforce management platform securely captures care plan notes and physician orders. Just as importantly, it keeps staff up to date through seamlessly tracking care plan changes and obtaining healthcare providers’ orders in real-time.
Supply cost billing efficiency
The new PDGM requirements state that supply costs must be reported every 30 days with each final claim submitted. Manually tracking which supplies and equipment were used for which patients and when is time consuming and leaves room for error.
A mobile workforce management tool streamlines the process so that providers can quickly document onsite what supplies were used during patient visits. This allows HHAs to have more accurate and efficient supply cost billing, cutting out some of the manual labor and admin work typically involved.
Scheduling for LUPA thresholds
Prior to the 2020 PDGM changes, a Low Utilization Payment Adjustment (LUPA) had a threshold of five visits for a 60-day episode. If a patient received five visits within that time frame, the HHA received a full 60-day episodic payment. But, if there were fewer than five visits, the HHA only was paid per visit.
Under the PDGM changes, an HHA receives per visit payments, based on the volume of visits within a 30-day payment period. The number of visits depends on the 432 patient groupings—each has its own LUPA level that ranges from two to six visits for each 30-day payment period. Hence, a missed visit in a 30-day period could mean the HHA losing thousands of dollars per episode.
A mobile workforce management platform helps ensure that LUPA thresholds and the right provider and services are identified—and services are started sooner—in each episode of care, as well as the correct number of visits are applied and fulfilled for each episode of care. Also, a mobile workforce management platform makes it easier to track resource utilization and patient visits, as well as bill, more quickly and efficiently.
Comorbidity adjustment scheduling
A secondary diagnosis can impact reimbursement by adding a comorbidity adjustment to a HHRG score. To accurately indicate the condition of the patient, several diagnosis codes can be reported on each claim.
A mobile workforce management tool promotes proper scheduling and documentation, which is critical to providing the necessary clinical resources for a care episode. This helps HAAs ensure that the appropriate resource is matched to the right patient based on the care that they need. Furthermore, any comorbidity adjustment can add an additional 15% payment to an episode of care.
Easily Adapt to the PDGM Changes
The 2020 PDGM changes affect how and when HHAs are reimbursed for care. It no longer allows reimbursement based on the volume of therapy visits, but rather on claims data, diagnosis codes, OASIS, and comorbidity adjustments. Furthermore, billing must occur over two, 30-day periods, which significantly affects staffing and presents operational challenges that must be handled with great operational oversight and care for the patient.
From accurate intake and faster referrals to on-time billing periods to real-time visit documentation and more, a robust mobile workforce management platform helps your HHA navigate the PDGM changes and thrive.
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