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AHCC Successfully Led Effort to Resolve 7th Character Issue with CMS

The Association of Home Care Coding & Compliance (AHCC), a division of DecisionHealth, and its credentialing body, the Board of Medical Coding & Compliance (BMSC), proudly announce that due to exhaustive efforts the Home Health Prospective Payment System (PPS) Final Rule includes a critical correction.

In the final rule, CMS states it will reissue the PPS payment logic (grouper) to award case-mix points for certain initial encounter codes (seventh character “A” codes), effective Jan. 1, 2016, but retroactive to all claims with a M0090 date on or after Oct. 1, 2015. In determining which diagnosis codes would be appropriate for home health to indicate that care is for an initial encounter, CMS and the cooperating parties developed a revised translation list to be posted to CMS’ website, although the federal agency did not indicate when the list would be posted.

Knowing the soon-to-be-released AHA Coding Clinic guidance regarding use of the 7th character A (initial encounter) would have a devastating impact on home health agency revenue, AHCC and BMSC board members sent letters to key stakeholders within CMS outlining the issue, the impact, and the urgency to find a remedy.

Leading home health and hospice associations were approached for their support in petitioning CMS to address the issue; and, were invited to become part of the Home Health and Hospice ICD-10 Transition Workgroup to proactively identify emerging ICD-10 issues and collaboratively work with the Coding Clinic and CMS to quickly resolve those issues.

The Alliance for Home Health Quality and Innovation (AHHQI), the National Association of Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organizations (NHPCO), and the Visiting Nurses Association of America (VNAA) joined the workgroup. And, Dr. William Rogers, CMS ICD-10 Ombudsman, will meet with the group regularly to quickly resolve issues as they arise.

“Home health and hospice now have a seat at the coding guidance table,” says Tricia Twombly, BSN, RN, HCS-D, HCS-O, COS-C, CHCE, AHIMA approved ICD-10-CM certified trainer, ICE Certified Credentialing Specialist and CEO of BMSC. “The community of providers has a voice through AHCC and through the ICD-10 Transition Workgroup. We are being heard. These are exciting times.”

About AHCC
AHCC is the community for professionals dedicated to providing quality care in post-acute care settings and establishing, meeting, and maintaining standards of excellence in their area of expertise.

AHCC’s credentialing arm, the Board of Medical Specialty Coding & Compliance (BMSC), offers professional credentials, including the only nationally accredited home health coding credential that tests coding skills exclusively, the Home Care Coding Specialist—Diagnosis (HCS-D), and the only nationally accredited OASIS credential, the Home Care Clinical Specialist – OASIS (HCS-O).

BMSC has been credentialing home health coders since 2003. More than 63% of agencies require coders to have earned the HCS-D credential as a condition of employment. The credentials are overseen by an independent board of home health and OASIS experts nationally recognized as leading authorities. Each board member has more than 25 years of experience in home health and hospice, and all are in-demand home health and hospice coding educators.

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