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CMS Adds Correction to PDGM Billing Instructions

Posted on Monday, June 3, 2019 1:23 AM

As we covered earlier this month here, CMS issued some revisions on claims processing under PDGM.  Recently, CMS indicated it would be correcting the changes to reflect the new diagnosis instructions that were added to section on home health.

Specifically, under PDGM ICD-10 codes used for payment groupings will be taken from claim instead of the OASIS.  Due to this change, the claims and OASIS diagnosis codes will not be expected to match in all cases.   Second 30-day claims in any 60-day period will not necessarily match the OASIS assessment.  When diagnosis codes change between one 30-day claim and the next, there is no requirement for HHAs to complete an OASIS Other Follow-up Assessment (RFA05) just to ensure that the diagnosis codes match the assessment.  However, the HHA is required to complete the RFA05 when there is a change due to major decline or improvement in the health status of the patient.

To reiterate, this change was not reflected in the RAP section of the Manual and is now corrected.

Source: NAHC Report

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