Blog Articles and Industry Updates
View the latest home health care and hospice industry updates and detailed information from our Blog articles.
Referral Source under PDGM – How it Impacts Home Health Agency Revenues
Community hospitals are struggling, and 21 more closed in 2018. Under Medicare’s PDGM commencing in January 2020, home health agency referrals are one of the primary determinants of the calculated reimbursement amount for billing claims. Since most home health agency (and hospice) clients are Medicare-insured, recognizing the markedly increased importance of both referral source and referral timing to your agency’s revenue stream is critical.
Medicare’s Patient-Driven Groupings Model and RCD Project
Sweeping Medicare and Medicaid regulatory changes have recently impacted home health agencies and skilled nursing facilities. Due to CMS payment model changes, home health and hospice agencies adapting to the Review Choice Demonstration (RCD) project have been burdened with also adapting to imminent changes under the Patient-Driven Groupings Model (PDGM).
Medicare’s PDGM, Open Enrollment, and Home Healthcare Agencies
Ensuring the accuracy of your home healthcare clients’ insurance can be particularly labor-intensive for your staff following Medicare’s annual “open enrollment” period. Overlapping Medicare’s “open enrollment” period in 2019 (from October 15 - December 7) is your...
RAP Payment Changes Impacting Home Health Agencies under PDGM – Part 2
Home healthcare and hospice agencies have utilized Medicare’s Request for Anticipated Payment (RAP) mechanism to maintain adequate cash flow. However, the Centers for Medicare and Medicaid Services (CMS) plans to phase out the RAP mechanism under the new Patient-Driven Groupings Model (PDGM) that commences on January 1, 2020. As reported in a recent article in Home Health Care News, this may create a significant cash flow squeeze (and especially for small and newer agencies with a large proportion of Medicare-enrolled clients).
RAP Payment Changes Impacting Home Health Agencies under PDGM
Home healthcare and hospice agencies have utilized Medicare’s Request for Anticipated Payment (RAP) mechanism to maintain adequate cash flow. However, the Centers for Medicare and Medicaid Services (CMS) plans to phase out the RAP mechanism under the new Patient-Driven Groupings Model (PDGM) that commences on January 1, 2020. As reported in a recent article in Home Health Care News, this may create a significant cash flow squeeze (and especially for small and newer agencies with a large proportion of Medicare-enrolled clients).
Home Health Agency Impact of Patient-Driven Groupings Model and PDPM
Home healthcare providers are bracing for the switch to the Patient-Driven Groupings Model (PDGM) in January, 2020. Meanwhile, the switch to the Patient-Driven Payment Model (PDPM) by rehab centers and nursing homes occurred in October, 2019. These are both value-based payment models of the Centers for Medicare and Medicaid Services (CMS) that impact reimbursements for services provided to patients (or clients) covered by Medicare or Medicaid.
Your Client’s Home Health Resource Group Impact on Medicare Payments
The classification of clients into a Home Health Resource Group (HHRG) is undergoing a change under Medicare’s new Home Health Agency-focused payment model. This new model changes the current case-mix payment system into one expanded to 432 possible case-mix groupings. Meanwhile, a referral designation for each Home Health Agency (HHA) client as either institutional or community is incorporated into the HHRG under this value-based payment model –termed the Patient-Driven Groupings Model (PDGM).
Projecting Monthly Cash Flow and Your Home Health Agency
Medicare enrollees are the “bulk” of most Home Health Agency (HHA) client pools. However, the complexity of obtaining reimbursement from the Centers for Medicare and Medicaid Services (CMS) has increased hugely due to one particular payment model change. The Patient-Driven Groupings Model (PDGM) – effective as of January 1, 2020 –not only requires a change to 30-day payment periods. It also changes the capacity to utilize clients’ diagnoses and Home Health Resource Group (HHRG) classifications to predict claims payment amounts. As described in Home Health Care News in 2019, the switch to the PDGM – for 50 percent of HHAs – is expected to tighten cash flow.
Home Health Care Billing and the Medicare Plan of Care
No payments can be made by Medicare to a home health care agency for care provided to a client unless a Plan of Care (CMS document 485) for that client was previously submitted. Furthermore, this Centers for Medicare and Medicaid Services (CMS) form must be completed every 60 days for each client receiving home care services. Therefore, developing a project management strategy for your home health care staff is imperative in order to ensure that Medicare will reimburse your agency located in Illinois (or elsewhere in the US) for the care provided to your clients.
Medicare’s Patient Driven Groupings Model (PDGM): Your Dementia Clients
Home health agencies will face a changed Medicare billing landscape in 2020, and a comprehensive management plan for this transition is critical. Implementation of the CMS’ Patient Driven Groupings Model (PDGM) will not only switch the unit of home health care payment from a 60-day episode of care to a 30-day period, but will also change the case mix adjustment impacting your agency’s level of payment.
Multiple Sclerosis and Autoimmune Disorders – Impact of Medicare’s PDGM
Your home healthcare clients with specific diagnoses may become Medicare beneficiaries at a younger age than 65. If you have a client with Multiple Sclerosis (MS) or another neurodegenerative disorder, the Social Security Administration’s approval for receipt of Social Security disability benefits (for at least 24 months) may signal that this client is eligible for Medicare coverage regardless of age. Likewise, clients with autoimmune disorders resulting in permanent disability status may also be Medicare-eligible before 65 years of age. In turn, that change in insurance coverage can have a major impact on your home health billing and revenue.
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