(Left to Right ) Lori Dixon Johnson, Shannon Zoffka, Dawn Jensen and Jolynn Harger pause last Wednesday afternoon, Feb. 5, while continuing training on the new Medicare and Medicaid Servicesr reimbursement system at the Tama County Health and Home Services Office in Toledo. Chronicle/John Speer

Effective Jan.1, 2020, Centers for Medicare and Medicaid Services (CMS) implemented a new reimbursement system, PDGM (Patient Driven Grouping Model), for Home Health Services. This changed how home health providers are reimbursed for Medicare services. Instead of being paid a 60 day episode period, providers are paid two 30 day episodes. CMS uses primary diagnosis codes, to determine payment for services, of the 70,000 codes CMS has made a total of 29,000 codes, no longer acceptable. The client assessment, done by the registered nurses has to be completed and submitted to CMS using correct coding for reimbursement.

On Oct. 1, 2019, Tama County Public Health & Home Care received an email from their current software vendor, stating that they would no longer do any Medicare Regulatory updates to their software.

In order to meet these Jan. 1, 2020, regulatory changes, Tama County Public Health and Home Care researched several different software vendors. Their current software vender offered another one of their products for approximately $5500/month. They currently pay approximately $1600 month for software services. Looking at a short turnaround time, they chose a software vendor that gave them the quickest opportunity to “go live” by March 1st, and at a lower monthly rate of approximately $3600/month.

Other software changes coming up is an Electronic Visit Verification mandate for Medicaid clients (Iowa currently has a waiver to end “sometime this calendar year”) and going to total EHR’s (Electronic Health Records). “With these CMS mandates, it is greatly impacting our budget to provide services. Increases include software support services, purchasing of iPads/cases, and data plans for the staff to do electronic charting” said Shannon Zoffka, CEO /Executive Director.

They are having to recreate and tailor their new software. With being a public health/home health agency, to meet both of these needs, it is taking some additional set up to meet documentation, cost reporting, billing, and tracking needs.

Tama County Public Health and Home Care staff have had numerous hours of training, including: online class, webinars, weekly meetings, and 3 full days of onsite training. They have been setting up payers, physicians, organizations, users, testing patient scenarios, and learning all the different steps involved with being able to generate required paperwork and billing.

Lori Dixon Johnson, Shannon Zoffka, Dawn Jensen and Jolynn Harger were “tested” on their competencies regarding the training that they received. They had to pass with a 75 percent competency rate in order to continue to go “live” March 1. They passed with a score of 95 percnt.

Using this train the trainer approach, these four staff members will train the rest of their staff on how to enter new clients, chart the services provided to the client and record their time to different programs into their new software system.

Their next phase in this training is to compile screen shots, notes, and information so they properly train the rest of the staff. With these new changes all staff will be given iPads for their documentation, access to agency email, and HIPAA compliant communication venues to share patient information.

“Being part of a Public Health and Home Health agency can be challenging and rewarding, but the staff here do a terrific job working together as we move forward learning as a team!”, said Zoffka.