Home Health & Hospice

Insider’s scoop | Working with the HHRG

Homecare Insider, June 27, 2016

Editor’s note: This week’s Insider’s scoop is from The Home Health Guide to Medicare Service Delivery, 2016 Edition, a one-stop solution for home health professionals looking for answers to Medicare compliance questions. Click here for more information.

The CMS and medical reviewers pay close attention to patterns in care delivery and Home Health Resource Group (HHRG) data. They are looking for trends indicating that payment is driving care delivery. Surveyors and intermediaries will focus on the accuracy and consistency of the information and how it is used.

The 2008 revisions to the case-mix structure made it very difficult for any individual to memorize the case-mix items and scoring, which is probably a good thing. That may mean less manipulation of assessments and diagnoses to increase points. Follow these tips:

  • Read and understand the instructions in the OASIS-C1/ICD-10 Guidance Manual for completing the data elements. Responses must be consistent with other documentation in the clinical record.
  • Score the patient accurately. Do not “tamper” with assessment findings just to achieve a higher HHRG score. That can lead to charges of fraud and abuse.
  • Incorporate assessment findings into care planning. The plan of care should revolve around the patient’s diagnoses.
  • Know how to determine, sequence, code, and document diagnoses.
  • Obtain appropriate orders for therapy.
  • Include interventions to address identified findings, such as pain, wound, ostomy, or dyspnea.
  • Evaluate the patient’s need for assistance with any limitations identified in the func¬tional dimension.
  • Monitor the consistency of assessment findings with documentation in the clinical record.