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.
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.
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.
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
Users also have convenient access to Change in Focus forms through the Patient Charts.
Patients tab ➜ Patient Charts ➜ Change in Focus button
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.
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