Maine Medicine Weekly Update - 08/26/2019  (Plain Text Version)

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In this issue:
IN THE SPOTLIGHT
•  MMA Annual Session in Bar Harbor September 6-8
•  MaineHealth & Anthem to Form Joint Insurance Venture
•  Celebrate 65 Years of MMA Executive Leadership on Oct. 26. Tickets Available Now
•  CDC: Many Adults Skip Diabetes Meds Due to Cost
•  Home Health Changes in CMS Rules: Implications for Primary Diagnosis
•  This Week's Public Health Updates from the AMA
•  USPSTF Updates Recommendations for Breast, Ovarian Cancer Gene Screening
•  CDC Videos on Discussing Vaccines With Parents, Patients
•  AMA Urges CMS to Reduce Administrative Burden on Physicians
129th MAINE LEGISLATURE
•  MMA Legislative Calls Finished for the Session
•  Legislature Returns to Augusta for a Day August 26th
UPCOMING EVENTS
•  Upcoming Specialty Society Meetings
•  MICIS Individual Academic Detailing Sessions on Opioid Topics
•  2019 Clinical & Legal Opioid Update: September 10th at the Augusta Civic Center
•  2019 Clinical & Legal Opioid Update: MICIS Fall Presentations
•  VA Maine Healthcare System to Host Community Mental Health Summit on MAT September 11th
•  Quality Counts: Rapid Induction Starting in the ED (RISE) Training, ECHO Program
•  Obesity Medicine: There is no 'one size fits all' - Monthly Lecture Series Beginning September 18th
•  Maine Concussion Management Initiative (MCMI) Training Program - October 9
•  MMA partners with the Maine Suicide Prevention Program to offer training for clinicians.
HEALTHCARE EMPLOYMENT OPPORTUNITIES
•  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
VOLUNTEER OPPORTUNITIES
•  Opportunities at the VA for Volunteer Physicians
•  Volunteer Opportunity with Partners for World Health

 

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.  

 

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