Quality review accuracy: An essential part of success under HHVBP
We’re back with the next step in our free, 8-week educational series Countdown to Value-Based Purchasing: 8 steps to prepare in 2022. But first…
An important update from the CMS: In its 2022 home health final rule, released on Tuesday, November 2, CMS has adjusted the implementation timeline of the Home Health Value-Based Purchasing model. 2022 is now the “pre-implementation year” and 2023 is the first performance year. The first year for payment adjustments will be 2025.
This change means agencies will now have more time to prepare before the national expansion of HHVBP begins impacting payments. But don’t wait! Use this extra time to your advantage and begin preparing now to set your agency up for success!
In step 4 of our Countdown to Value-Based Purchasing, we are focusing on the components of a comprehensive quality review program and how to take what you learn to achieve performance improvement.
Assigning appropriate diagnosis codes
Appropriate diagnosis codes should be assigned by a coding professional based on the assessing clinician’s focus of care. It is important that the coder and clinician work in collaboration, as it is the assessing clinician who determines which diagnoses should be included on the plan of care and the OASIS. Your diagnosis coding impacts the risk adjustment applied to your OASIS items under HHVBP, so it is vital that you capture these codes accurately so that your outcomes are not negatively impacted.
Ensuring appropriate OASIS responses
OASIS items throughout the assessment should have the appropriate responses and accurately reflect the safety needs of your patient. Your quality reviewers should have a strong understanding of the key concepts of OASIS guidance and be up to date on the most recent guidance through CMS’s quarterly Q&As and the current OASIS guidance manual.
How are you using your quality review data?
To succeed under HHVBP, your QAPI program should include a plan for taking the data you collect from your quality reviews and turning that data into an appropriate performance improvement plan. Are you seeing specific OASIS items needing corrections more than others? You should be using that information to create a performance improvement plan directed toward those items in order for your clinicians to drive performance improvement. This will ensure that your outcomes are reflecting both your patient population and the care you are providing and will ultimately ensure that your agency has the appropriate reimbursement adjustment under HHVBP.
Next steps
To learn more about the key steps in an accurate and comprehensive quality review, visit wellsky.com/HHVBP and watch this week’s episode.