PDGM Check-In: ‘There’s a Slight Sense of the Wild West’

With just five full months to go before the Patient-Driven Groupings Model (PDGM) becomes a reality, home health providers have reached crunch time. As it has been all along, the assumption-based behavioral adjustment baked into PDGM remains the home health industry’s No. 1 issue. Orginally, the behavioral adjustment was estimated to create a 6.42% payment […]

OIG Calls for Additional Oversight of Home Health, Personal Care Service Providers

In a new report released Monday, the U.S. Department of Health and Human Services Office of Inspector General (OIG) highlighted dozens of its unimplemented recommendations for reducing fraud, waste and abuse throughout the Medicare and Medicaid systems. Many of the recommendations were tied to home health, hospice and personal care services, in addition to how […]

CMS Proposal Takes Home Health Agency Closure Estimates and ‘Lights Them on Fire’

After federal health care policymakers fine-tuned the Patient-Driven Groupings Model (PDGM) last October with a 6.42% cut based on certain behavioral assumptions, some industry experts predicted there would be a modest uptick in home health bankruptcies in 2020. “The last time the industry went through this kind of major change was in the late 1990s […]

Why CMS’s Home Health Therapy Proposal May Not Be Enough

As part of its Patients Over Paperwork initiative and as a way to make home health requirements more consistent with other settings of care, the Centers for Medicare & Medicaid Services (CMS) is proposing to allow therapist assistants to furnish maintenance therapy. Under current home health rules, only physical therapists (PTs), occupational therapists (OTs) and […]

Game On: PDGM Encourages Home Health Agencies to ‘Game the System’

When the Center for Medicare & Medicaid Services (CMS) developed the Patient-Driven Groupings Model (PDGM), part of the goal was to fix problems that exist with the currently used Prospective Payment System (PPS). One such problem, government watchdogs say, is agencies prioritizing quantity of care over quality because it often leads to more money. Thus, […]

CMS Finding New Ways to Penalize Home Health Providers

The Centers for Medicare & Medicaid Services (CMS) is finding new ways to penalize home health providers. In its proposed payment rule for 2020 released last week, CMS floated the idea of phasing out pre-payments for home health services starting in 2020, killing them completely by the following year. Currently, home health providers can receive […]

NAHC’s Dombi: CMS Needs to ‘Back Off’ RAP Proposal, PDGM Assumptions

The looming Patient-Driven Groupings Model (PDGM), a potential hospice carve-in under Medicare Advantage (MA) and the expanding Review Choice Demonstration (RCD) are just a few of the developments reshaping the current landscape of home health and hospice. As if those three items aren’t enough, providers are also facing the continuing Value-Based Purchasing Model (VBPM), emerging […]

[Updated] CMS Proposes Elimination of RAPs, $250 Million Medicare Payment Increase

The Centers for Medicare & Medicaid Services (CMS) is moving forward with many of the provisions originally included in the Patient-Driven Groupings Model (PDGM) while also proposing to implement a new home infusion benefit, eliminate home health pre-payments and make Value-Based Purchasing Model (VBPM) performance data public. CMS detailed its plan for PDGM and other […]