PDGM Series: Clinical Groupings & Comorbidity Adjustments

By Melinda A. Gaboury, CEO / Posted on: October 1, 2019

Transitioning to the Patient-Driven Groupings Model (PDGM) has already begun to impact operations for home health agencies that are indeed convinced that preparation must begin now.  Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by deeper education and understanding of both items.  Clinicians must understand the dire importance of including the appropriate disease processes in the assessment of the patient and development of care plans.


FY2020 Hospice Final Rule: Changes to Hospice Reimbursement

By Leslie Heagy / Posted on: September 10, 2019

The rule rebases the continuous home care, general inpatient care and the inpatient respite care per diem payment rates in a budget-neutral manner to more accurately align Medicare payments with the cost of providing care. In addition, the rule modifies the election statement by requiring an addendum that includes information aimed at increasing coverage transparency for patients under a hospice election. Finally, this rule includes changes to the Hospice Quality Reporting Program.


PDGM Series: The 2020 Proposed Rule Update

By Melinda A. Gaboury, CEO / Posted on: August 27, 2019

January 1, 2020 will bring many new beginnings, including the Patient Driven Groupings Model (PDGM). No doubt the largest reimbursement system overhaul in home health since October 2000.
CMS continues to tweak the model and updates to the Claims Processing Manuals have begun.


OASIS-D1 Update & PDGM Impact

By Melinda A. Gaboury, CEO / Posted on: July 1, 2019

CMS has announced that the revised OASIS-D1 instruments will be effective January 1, 2020. Changes to the OASIS-D data set and data collection guidance were finalized in the Calendar Year (CY) 2019 HH Final Rule, CMS 1689-FC.