It's really important that we as an industry begin to benchmark supply cost and best practices and that's something that just hasn’t occurred up until now. And we're just now being better able to really focus on this and that's because, number one, the vast number of different types of supplies and codes matching that to diagnosis has been an impossibility because we've never thought of supplies in that way. Go through this expert home health training article to know more about the NRS home health rules and guidelines.
Let us look at a little case study. Mrs. Jones is an 80-year old woman in her first episode of care. She's seen for dressing change to sacral decubitus ulcer and that was the primary reason she was referred and for physical therapy due to debilitation from a CVA six months ago.
She's projected to have nine nursing visits and six therapy visits. And their HHRG is C1 F2 F2 for a case weight of .93. And for CVA, she did get a point. She didn’t get any points for COPD because it was coded in a very generically here and it does another whole exercise and learning.
But COPD for ICD-9 code 496 is not a specific diagnosis code. There are five codes in table 2B that will tell you very specifically what type of COPD a patient would have. And we need to work on making sure that we get those specific codes. At MO490, she got two points. But she didn’t score anything at MO460 because the OASIS, now termed OASIS C, didn’t have anything there. So that's very odd. How could she have not gotten any HHRG points there?
But her functional elements were scored and she had a total of six functional points. And then when one tried to price this out, her non-routine supply severity level was a one because there were no points there basically.
Her add-on was then the $14.12. Her revenue is $2,132.51 plus the non-routine supply revenue add-on and it became $2,146.63. So what was discovered was that since MO450 wasn’t completed. Mistakes cost money. The pressure ulcer hadn’t been staged. We lost five case mix points here at MO460 because MO450 wasn’t completed and there was no staging.
So once we stage the ulcer, most problematic pressure ulcer stage 1 or 2, score of two, she got five points. So our functional points remain the same but we went to a OASIS C2, the clinical domain points changed because we had it five points and it took us into the next level. So she then became a C2 F2 F2 and the revenue was $2,474.88 for a case weight of 1.0901.
Then at that point, she had 14 non-routine supply points because we staged the ulcer and at MO460, she had a problematic pressure ulcer. But MO450 identified that she had a stage 2 ulcer. So she became a non-routine supply severity level two for an add-on of $51 and total revenue here of $2,525.88.
Now, it might be a little confusing at the bottom because what we are saying here is that’s additional revenue. The additional HHRG revenue is pretty clear. We went from a C1 to C2 and we received $342.37 more in the HHRG but we received an additional $36.88 in NRS revenue.
And what we mean by that is now, we're severity level two and we received $51. But we are pretending that this is a patient that we have in our agency and at oversight of OASIS review, we identified that MO450 hadn’t been staged. And so, because we staged it, we received $36.88 more than we would have had we not staged it. So the total additional revenue came to $379.25 for that episode just because went back and staged the wound.
Consider the total CMS OASIS impact and this is another point that we think is really important for us to think of. And you need to, at some point, look at the diagnoses table, table 10B that is included in the CMS tables and this is what tells you garners points what diagnoses are included to get non-routine supply points as well as other case mix items including pressure ulcer staging. So those items plus the diagnosis give you your non-routine supply payment and equal your total revenue.
The new staff really had not had any type of concentration taking care of wounds. And it really didn’t always know exactly the difference between pressure ulcers, stasis ulcers, diabetic ulcers and arterial ulcers.
These are very important distinctions to know because again, everything has a different weighting as far as either HHRG points and/or non-routine supply points according to the home health rules. So you can see how closely intertwined the knowledge about the clinical care is to revenue. And remember and you know only pressure ulcers are staged.
Visit our home health guidelines page and get more details on new reporting requirements for optimum supply reimbursement.