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One of the latest new payment models to watch is the Patient Driven Payment
Model (PDPM), which will replace the current case-mix classification system,
the Resource Utilization Group Version IV (RUG-IV), for skilled nursing facilities
(SNFs) starting on Oct. 1, 2019. As part of the new model, SNFs will use a new
per-diem prospective payment system to submit claims for Medicare Part A services.
Payment hinges on clinically relevant factors, so accurate coding is essential.
Costello believes PDPM could present an opportunity for coding professionals
who study the models to support their revenue cycle teams during the transition.
To that end, AHIMA has partnered with the American Health Care Association
(AHCA) to provide training on ICD-10-CM and PDPM for coding and non-coding
professionals. The resources will be available to purchase this spring on the AHCA
Supporting Your Organization
To help members address some of the major changes in the coding world, AHIMA’s
Clinical Terminology and Classification (CTC) Practice Council has been developing
new resources for members, says Faith McNicholas, RHIT, CPC, CPCD, PCS, CDC,
who co-chairs the council and is manager of coding and reimbursement at the
American Academy of Dermatology, Rosemont, IL.
In January 2019, the practice council released an article on “Components of an
Effective Outpatient Coding Compliance Policy Program.” Outpatient coding has
been a hot topic among AHIMA members, not just because of E/M changes but also
because of new, non-face-to-face encounter code updates and reimbursement rules.
“There are a lot of changes happening with American Medical Association Current
Procedural Terminology (AMA CPT) and CMS [rules] as they continue to improve
patient access to care by incorporating and supporting electronic services,” she says.
“As such, I would encourage those in outpatient settings to stay tuned to the AHIMA
Engage community and AHIMA Journal as we continue the discussion on coding,
classification, and reimbursement,” McNicholas says.
For HIM professionals in inpatient settings, the practice council has been working
on an inpatient coding compliance article that will be published in the June Journal
of AHIMA. The group also is developing a practice brief on CC/MCC (complication
or comorbidity/major complication or comorbidity) capture rate best practices
that will be published in the same issue. Additionally, the practice council recently
collaborated with the Clinical Documentation Improvement Practice Council on the
“Best Practices for Denials Prevention and Management” practice brief, which was
published in the March 2019 Journal of AHIMA.