Home Health Coding Opportunity
Could Your Home Health Agency Be Leaving Reimbursement on the Table?
Under Medicare's Patient-Driven Groupings Model (PDGM), the selection of a clinically appropriate primary diagnosis can significantly influence reimbursement. Berg Data Solutions analyzed Medicare Home Health claims nationwide and identified meaningful opportunities for coding improvement.
Explore the interactive map below to see how potential coding improvement opportunities vary across states, including total financial opportunity, average opportunity per agency, opportunity as a percentage of Medicare revenue, and average number of ICD-10 codes used.
Berg Data Solutions analyzed Medicare fee-for-service Home Health claims for potential reimbursement improvements.
The map summarizes estimated coding improvement opportunities by state, including total financial opportunity, average opportunity per agency, and opportunity relative to Medicare payments. It also illustrates variation in the average number of ICD-10 diagnosis codes used.
Important: These findings represent modeled reimbursement opportunities, not guaranteed additional payments. Any coding changes must accurately reflect the patient's clinical condition, documentation, and applicable Medicare coding requirements.
What does this mean for your agency?
National and state-level trends tell only part of the story.
Berg Data Solutions' coding optimization tool helps Home Health agencies evaluate clinically appropriate primary diagnosis alternatives and identify potential reimbursement improvement opportunities.
Interested in learning more? Contact us to explore how coding optimization could support your agency's financial performance.