September 3, 2019

In This Issue
MMA Gathers for Annual Session in Bar Harbor This Weekend
Portland's PIER Program Featured in New York Times Article
US CDC Asks Physician Help on Vape-related Lung Diseases
New Resource Elucidates Climate Change Impact on Health and Health Care
Maine CDC to Hold Rulemaking on Death With Dignity
EEE Found in Maine Horse
Johnson & Johnson to Pay $572 million in Opioid Case
This Week's Public Health Updates from the AMA
DHHS Commissioner Lambrew and Insurance Superintendent Cioppa Host Health Care Forum
Home Health Changes in CMS Rules: Implications for Primary Diagnosis
CDC Videos on Discussing Vaccines With Parents, Patients
MMA Legislative Calls Finished for the Session
Upcoming Specialty Society Meetings
MICIS Individual Academic Detailing Sessions on Opioid Topics
2019 Clinical & Legal Opioid Update: Tuesday, Sept 10th at the Augusta Civic Center
MICIS: 2019 Clinical & Legal Opioid Update - Fall Dates Scheduled
VA Maine Healthcare System to Host Community Mental Health Summit on MAT September 11th
Qualidigm Rapid Induction Starting in the ED (RISE) Training
Obesity Medicine: There is no 'one size fits all' - Monthly Lecture Series Beginning September 18th
Maine Concussion Management Initiative (MCMI) Training Program - October 9
Celebrate 65 Years of MMA Executive Leadership on Oct. 26. Tickets Available Now
MMA partners with the Maine Suicide Prevention Program and the Maine CDC/Sweetser to offer training for clinicians.
Nurse Practitioner
Full-time, Part-time and Leadership Opportunities for Physicians
Outpatient Internal Medicine Physician Bangor, Maine
BC/BE Family Medicine or Internal Medicine Physician
Northern Light Sebasticook Valley Hospital seeks a BC/BE General Surgeon
Family Medicine Opportunity in Beautiful Western Maine
Physician Director of Primary Care
Family Medicine Specialist or an Internist
Opportunities at the VA for Volunteer Physicians
Volunteer Opportunity with Partners for World Health

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Home Health Changes in CMS Rules: Implications for Primary Diagnosis

The Home Health industry is looking toward significant changes on January 1, 2020 related to the Medicare reimbursement and payment. The industry will transition to a Patient Driven Grouper Model (PDGM) which will require a greater focus and importance on the Primary Diagnosis. The Primary Diagnosis will be a key factor in determining home health reimbursement as well as patient care and services.  

Starting in 2020 this model of payment will not accept 40% of the Diagnoses that are currently being used as the Primary diagnosis. These are mainly symptom codes that do not give enough specificity as to the reason for the need for home health services. Studies show that 15% of current home health claims will not be in compliance in 2020 due to unacceptable Primary diagnoses, the number one Diagnosis used being Weakness M62.81.

Examples of these diagnoses that will not be accepted as the primary diagnosis include:

M62.81 Muscle Weakness

R26.89 Other abnormality of gait

R26.81 Unsteadiness of feet

R29.6 Repeated falls

R53.1 Weakness

R33.9 Retention of urine

Dysphagia, unspec.

M25.561/M25.562 Pain in right/left knee

M25.551/M25.552 Pain in right/left hip

M54.9 Dorsalgia, unspec.

M25.511/M25.512 Pain in right/left shoulder

M54.5 Low back pain

M19.90 Unspecified Osteoarthritis, unspecified site

M19.91 Primary Osteoarthritis, unspecified site

S72.001D Fracture of unspecified part of Rt femur

S72.002D Fracture of unspecified part of Left femur

In an effort to make sure all of our patients have Primary diagnoses that are acceptable to this new payment model by 2020, the Home Care & Hospice Alliance of Maine is sharing this information to alert Physicians and referral sources of this significant change.  Please assist home care and hospice providers transition to this new model by starting now to make sure all patients needing home health will have a specific Diagnosis rather than one that only identifies a symptom.

The care of our patients is always our top priority and we hope the implementation of this new model will only help us improve the services that we provide.

Thank you for your referrals to home care and hospice. 

Laurie Belden, Executive Director

Home Care & Hospice Alliance of Maine


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