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Creating a Retention Policy in the Age of PDGM

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The Patient-Driven Groupings Model (PDGM) went into effect on Jan. 1. Here’s what healthcare organizations need to know now about retention and storage.

The adage that if one is good, two is better is currently being tested by home healthcare and hospice organizations as they watch PDGM impact their records retention and storage policies.

PDGM, or the Patient-Driven Groupings Model, is a new rule from the Centers for Medicare & Medicaid Services (CMS). At its most basic, PDGM makes sense. The case-mix adjustment methodology went into effect on Jan. 1, changing the way agencies are paid. Now, home healthcare and hospice billing transforms from a single 60-day episode into two 30-day episodes, using case characteristics rather than how often the patient is seen to calculate a provider’s reimbursement fees. It’s a rule designed to reduce unnecessary patient visits and save money, as well as improve patient care.

The Shortcomings of PDGM

There are some downsides, though. From a record retention and storage standpoint, PDGM means that, in some cases, what was once a single patient case may now generate double the paperwork with no reduction in the length of time that paperwork must be stored. In addition, even if a patient’s case results in a single 30-day episode, documentation may still increase as providers are tasked with collecting more data about a patient’s health history.

This is why those organizations that didn’t plan ahead may feel overwhelmed, despite the fact that the rule was announced in July, 2018. However, organizations can take the following steps today to lighten their retention and storage burden.

Digitize Patient Records

Healthcare providers should do everything in their power to digitize the documentation and storage of patient records. Some organizations can help with these tasks, taking simple digital transformation to the next level. For instance, since CMS requires organizations to store medical records for seven years, they can create an updated retention policy that makes it easier to ascertain how old a document is and when it can safely and securely be deleted.

Classify Data for Accessibility

In addition, organizations need to be cognizant of data classification and security. Under PDGM, more employees may need access to patient files. It’s not just caregivers anymore who need to see a patient’s history, treatment plan and progress; staff members in billing and referrals will also need access to the files, as will salespeople — at least in an aggregate way — so they can look to bring in more business from facilities and hospitals that are easier to work with.

Solidify Backup and Recovery Plans

Since reimbursements are tied to documentation, it will be imperative for organizations to have strong backup and recovery plans in place. That way, digitized paperwork will always be accessible to everyone who needs it. Documents must also be stored in one place to maintain version control and prevent lost files.

Establishing best practices in records retention and storage policies as soon as possible is key for healthcare providers to stay on top of PDGM requirements. Digitization of healthcare data can lay the groundwork for streamlining processes under the new guidelines.

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