Under PDGM, each 30-day billing period has its own clinical grouping for calculating reimbursement. If a patient’s care focus in the first billing period changes, agencies may receive increased reimbursement for the second billing period.

Change in Focus Form

Using the Change in Focus form, agencies can easily document when a patient’s primary diagnosis is resolved and another existing diagnosis becomes the focus of care.

• When a patient’s primary diagnosis is resolved and another existing diagnosis becomes the focus of care, a new OASIS is not required. The clinician can use the Change in Focus form to seamlessly document the change in minimal time. Diagnoses documented in the Change in Focus form automatically flow to the second RAP/Final claim.

• When a patient’s diagnosis changes to a new diagnosis with new interventions that are not included in the current Plan of Care, an order must be written to include the new diagnosis and interventions along with the Change in Focus form.

• When a patient has a change in acuity, a new OASIS must be performed to document the significant change in condition.

The Change in Focus form must be used within the first 30 days of the episode to update the focus of care for the second 30-day billing period. Change in Focus forms and OASIS assessments have equivalent weight as they relate to claims. When completed after the most recent OASIS, the Change in Focus form provides diagnoses for the appropriate claims.

Create a Change in Focus Form

To document a patient’s change in focus, create a Change in Focus form in the Schedule Center. Navigate to the Schedule Center under the Schedule tab and select the appropriate Change in Focus task from the Task drop-down menu.

Schedule tab ➜ Schedule Center ➜ Select Visit Type in Task menu ➜ Change in Focus

Change in Focus in Patient Charts

Users also have convenient access to Change in Focus forms through the Patient Charts.

Patients tab ➜ Patient Charts ➜ Change in Focus button

Calculate Case-Mix

On the Change in Focus form, the Calculate Case-Mix button is available to users who have permission to see financial data. When selected, the PDGM Case-Mix Analysis opens to display the new case-mix calculation based on the patient’s updated diagnosis sequencing and most recent OASIS data for admission source and timing and functional impairment.

Case-Mix Permissions:

To give a user permission to access case-mix data, navigate to the Permissions tab in the user’s profile. In the Clinical permissions section, select View Expected Payment for HHRG/Case-Mix Analysis. Once this permission is granted, the user will be able to see the Calculate Case-Mix button to generate case-mix data in the Change in Focus form.

View tab ➜ Lists ➜ Users ➜ Edit ➜ Permissions tab ➜ Clinical section ➜ View Expected Payment for HHRG/Case-Mix Analysis

Updated on 12/30/2019