By Sharon Litwin, RN, MHA, HCS-D / Posted on: August 24, 2021
This article will detail eligibility requirements for Medicare home health patients—homebound, face-to-face, skilled need—and will discuss the new payment model, the Patient-Driven Groupings Model (PDGM). The article also includes case scenarios for home health patients that require IV therapy as well as other home health interventions for various disease processes and the Medicare Home Health Benefit and the HIT Benefit intertwine.
By Sharon Litwin, RN, MHA, HCS-D / Posted on: April 8, 2021
It remains challenging to code COVID-19 for patients, as there are so many variations seen, especially as time goes on. However, as of January 1, 2021, we have new diagnosis codes that are to be used for COVID-19 patients. They don’t include all of the patient scenarios for the conditions seen after COVID but it is a start.
By Melinda A. Gaboury, CEO / Posted on: December 29, 2020
Beginning 1/1/2021 the Request for Anticipated Payment (RAP) will no longer have a 20% payment associated with its processing. The RAP will continue to be a requirement for payment and ironically will be associated with a penalty if it is not accepted at the Medicare Administrative Contractor (MAC) by Day 5, the begin date of the payment period being Day 0. The penalty will be a daily amount as a proportion of the 30-day value related to the HIPPS code that the 30-day payment period is worth.
By Melinda A. Gaboury, CEO / Posted on: August 3, 2020
CMS released the CY 2021 Home Health Proposed Payment Rule in June 2020. The proposed rule contains several updates and changes. These changes include PDGM Rates, Wage Index, Telehealth, Quality Reporting Program, and Billing RAPS. The RAP issue alone is enough to warrant EVERY agency in the nation sending in comments and requesting that this be changed! We must stand together.
By Melinda A. Gaboury, CEO / Posted on: May 14, 2020
There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.
By Melinda A. Gaboury, CEO / Posted on: April 1, 2020
This article was last updated on May 7, 2020.
As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.
By Melinda A. Gaboury, CEO / Posted on: November 19, 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 should be underway. The first two pieces to the puzzle in establishing a Home Health Resource Group (HHRG) and corresponding case-mix weight are Admission Source and Timing. Both of these items are extremely important and will need meticulous attention at the Start of Care (SOC) and, for the Admission Source, that attention will need to continue into subsequent 30-day payment periods.
By Melinda A. Gaboury, CEO / Posted on: October 21, 2019
As home health agencies continue to plan for the implementation of PDGM there are some very important questions that agencies should be asking of the software vendors/electronic medical records (EMR) that will be utilized for clinical documentation and billing of Medicare Home Health claims.
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.
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.
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.
By Melinda A. Gaboury, CEO / Posted on: April 30, 2019
Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary driving force behind the OASIS changes.
By Melinda A. Gaboury, CEO / Posted on: August 8, 2018
The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.