Proposed Medicare Changes Threaten Home Health in Rural Markets

Throughout the past several years, home health providers operating in rural areas have received on-and-off payment bumps to help them overcome the inherent obstacles of operating in remote and sparsely populated areas. While relatively small, those payment bumps, officially known as rural add-on payments, have played an important, cost-effective role in allowing America’s non-city-dwelling-seniors age […]

CMS Proposes Medicare Advantage Changes to Expand In-Home Telehealth Coverage

The Centers for Medicare & Medicaid Services (CMS) on Friday unveiled a proposal to expand telehealth benefits in Medicare Advantage, making it easier for beneficiaries to access these services from home rather than a health care facility. Under the proposed rule, which would take effect in calendar year 2020, MA plans could cover telehealth services […]

CMS Proposes Pre-Claim Start Date, EVV Implementation Survey

The Patient-Driven Groupings Model (PDGM) has dominated the home health industry’s regulatory conversations of late, which is understandable, as it’s likely the biggest policy shift from the Centers for Medicare & Medicaid Services (CMS) in the past few decades. There are several other regulatory items flying under the radar, however, including the potential reincarnation of […]

LHC Group CEO: New Payment Model Could Be ‘Penny Wise and Pound Foolish’

The Patient-Driven Groupings Model (PDGM) is a once-in-a-generation type of change to the home health landscape, yet there is little data to back it up, according to Keith Myers, CEO and chairman of LHC Group (Nasdaq: LHCG). Myers is also chairman of the Partnership for Quality Home Healthcare, among the groups that together submitted more […]

New CMS Proposal Would Save Home Health, Hospice $137M Annually

Federal policymakers are again taking aim at costly administrative and paperwork burdens for the home health and hospice industries in order to help providers save tens of millions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) on Monday announced its latest proposed rule focused on minimizing burdens on home health agencies, hospice […]

MA Risk Adjustment Fails to Account for Beneficiaries’ Functional Limitations

Due to current risk adjustment methods, Medicare Advantage (MA) plans may be underestimating annual fee-for-service spending for beneficiaries with functional limitations and overestimating spending for those without them. If true, that could mean an even greater MA role for home health providers, who routinely gather, store and analyze data related to the functional ability of […]

PDGM Likely to Shake Up Patient Populations for Home Health Agencies

The latest proposed payment model from the Centers for Medicare & Medicaid Services (CMS) could shake up how the home health industry treats referrals that come from institutional¬†settings versus community-based ones. As a result of changes under the Patient-Driven Groupings Model (PDGM), agencies may start trying to form closer relationships with hospitals or skilled nursing […]

CMS Reports Widespread Quality Improvement in Latest Hospice Compare Update

The Centers for Medicare & Medicaid Services (CMS) updated data on its Hospice Compare website earlier this month—and all quality measures showed overall improvement. Launched in August 2017, the Hospice Compare tool reports information on hospices across the nation and is designed to give patients, family members and health care providers a snapshot of the […]

CMS Faces Decisions in Shaping Medicare Advantage Home Care Benefits

In a major change for the home care industry, Medicare Advantage (MA) plans have been granted new flexibility this year, which will allow them to cover non-skilled on-home services for the first time. However, it remains to be seen how much latitude the Centers for Medicare & Medicaid Services (CMS) will give insurance companies in […]

PDGM’s More Complex Approach to Comorbidity Adjustments Raises Doubts

The forthcoming Patient-Driven Groupings Model (PDGM) could potentially alter the way that home health providers are reimbursed for treating patients with comorbid conditions. These proposed changes should be among the elements of PDGM raising concerns for the industry, considering that they add complexity and yet could result in nearly 95% of providers getting very little […]