PDGM Released!

Attention: All Medicare-certified agencies

The HealthTrust platform received a significant update to its Prospective Payment System functionality on January 1, 2020 to accommodate the regulatory requirements of the new PDGM and OASIS D-1 rules. Summaries of these updates are listed below:

1. PPS billing is now divided into two separate 30-day periods within the one 60-day episode. PPS billing continues to function as it has, except that the Episode record now also include an indicator for "First 30 Days" or "Second 30 Days". The Episode "Status" field still controls when the RAP or Final Claim are created, but now the system will create a RAP and Final Claim for the First 30 Days and then create another RAP and Final Claim when the indicator is changed to "Second 30 Days."

Episode Indicator.png

2. An additional 15 diagnosis code fields have been added to the Patient profile and Claim record screens. This will allow the system to accommodate up to 25 total diagnosis codes on claims.

Diagnosis Codes.png

3. OASIS documents have been updated to reflect the requirements of the OASIS D-1 specifications. These new field updates will automatically be reflected on assessments with M0090 Date of Assessment of January 1, 2020 or later. A list of these changes can be found at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/OASIS-D1-Update-Memorandum_Revised_May-2019.pdf

Questions?

If you have questions or comments, or if you run into any problems, please contact your Business Advisor for immediate assistance.

Jonathon Kovar