Agencies wishing to ensure accurate payment for OASIS-C1/ICD-9 assessments beginning Jan. 1, 2015 will need to make sure their quality managers, educators and clinical directors study and understand that four diagnosis groups will no longer be used in scoring in the PPS Grouper released by CMS Nov. 10.
 
The diagnosis groups that no longer will be used in scoring, as also delineated in the final PPS 2015 rule, will be blindness and low vision, Psych 1, Psych 2 and pulmonary disorders, according to the Grouper.
 
CMS’ Grouper overview document is also useful to agency managers and billers in understanding and reviewing the rules for scoring diagnoses and can be used by billers to help determine why a payment may be rejecting, says Ann Rambusch, president of Rambusch3 Consulting, Georgetown, Texas.
 
Quality and clinical managers also need to pay attention to Table 4 in the Grouper overview that lists the case-mix adjustment variables and scores as also stated in the 2015 PPS final rule, Rambusch says. For instance, agencies no longer will earn points for diabetes or gastrointestinal disorders as a primary diagnosis in early episodes, whereas currently these diagnoses earn five and two case-mix points, respectively.
 
Related link: The Home Health PPS Grouper v4415 is available for download here: http://tinyurl.com/p8awmmp.