After four consecutive years of decline, home health and hospice dealmaking is gaining momentum — and the proposed CY2027 home health rule and the Medicare enrollment moratoria could propel activity even higher through 2027. Home health and hospice dealmaking could spike not only in volume, but also in valuation, according to a recent report from […]
Home-based care referrals are no longer won mainly on relationships. Health systems and payers are increasingly steering patients to agencies that can prove quality ratings, low hospitalization rates, fast acceptance, broad payer coverage and complex-case capability, industry leaders recently said in a Home Health Care News webinar. Home health and home care providers and both […]
Medicare Advantage, Medicaid managed care and federally facilitated ACA Marketplace health plans deny between 12% and 18% of standard prior authorization requests — denials that can act as a burden to home health providers. Prior authorization denial rates varied widely among the largest insurers in 2025, according to a recent study by KFF. “Health insurers […]
As the Centers for Medicare & Medicaid Services (CMS) and Department of Justice (DOJ) intensify anti-fraud enforcement in the home health industry, established providers are focusing on reinforcing quality, documentation integrity, proactive oversight and other compliance models already in place, leaders told Home Health Care News. “Our strategy is really about making sure people understand […]
Home-based care providers have long looked to both the Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage (MA) to push forward value-based care, but that balance may be shifting. CMS is driving value-based care growth more than MA, as federal models such as home health value-based purchasing (HHVBP) and the Transforming Episode Accountability […]
Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare & Medicaid Services (CMS) new fraud-fighting tools. The bill serves as a microcosm of how lawmakers appear to view the home health industry: with equal parts support and suspicion. It’s a […]
Sen. Susan Collins (R-Maine) has introduced a bill that, if enacted, would give the Centers for Medicare & Medicaid Services (CMS) additional tools to prevent and detect home health fraud and reset the Medicare home health payment rate to levels seen before years of payment cuts. The bill, called the Medicare Home Health Payment Integrity […]
The home-based care industry is shifting fast, with major leadership changes, new technologies changing the operational game and a significantly different regulatory landscape, including a federal-level fraud crackdown. Those are big, sometimes abstract forces. But what matters most is how provider leaders show up in an organization’s day-to-day operations: the referral documents someone has to […]
The Centers for Medicare & Medicaid Services (CMS) has expanded the Comprehensive Care for Joint Replacement (CJR) Model, which aims to encourage collaboration among health care entities — including home health providers. Most hospitals will be required to participate in the CJR Expanded (CJR-X) model beginning in January 2028. “CJR-X gives more patients the opportunity […]
The United States Department of Justice (DOJ) Fraud Division, U.S. Attorney’s Office and Pennsylvania Attorney General have charged 19 defendants for a $4 million fraudulent Medicare and Medicaid scheme involving home care. The schemes involved submitting claims for home health services that never occurred or billing an exorbitant number of hours within an unrealistic period, […]
