CMS: 80% of Home Health Agencies May Have Negative Margins by 2040

Medicare’s Hospital Insurance Trust Fund — which helps pay for Medicare Part A services, including in-patient hospital, skilled nursing facility, hospice and home health care services — is set to go broke by 2026, Trump administration officials reported Monday. What’s more, if current utilization and financial projections prove accurate, the vast majority of home health […]

CMS Launches Enhanced Oversight Initiative for New Home Health Agencies

With major regulatory volleys such as the Patient-Driven Groupings Model (PDGM) and the Review Choice Demonstration (RCD) on the table, keeping track of other industry-shaping issues can often feel like a losing battle. For some home health stakeholders, that may have meant missing a subtle yet important announcement from the Centers for Medicare & Medicaid […]

Credit, Billing Staff Are Keys to a Smooth Financial Transition into PDGM

When the Patient-Driven Groupings Model (PDGM) takes effect Jan. 1, home health care billing processes will become significantly more complicated. The new model revolutionizes the way agencies are reimbursed, cutting payment periods in half and requiring more detailed claims, among other changes. As a result, PDGM will likely put financial strain on even the most […]

How New Payment Models, Big Data Are Disrupting Home Health Care

While technology behemoths and up-and-coming startups are often cited as the industry’s top disruptors, it’s innovative payment models and big data that will likely have the greatest impact on home health care delivery over the next several years, experts predict. Additionally, as long as gaps exist throughout the hospital-to-home transition process, further disruption is sure […]

Senator Rand Paul Slams PDGM, ‘Guesses by Government Bureaucrats’

House lawmakers have yet to introduce a companion bill to the Home Health Payment Innovation Act (S. 433), legislation introduced in the Senate in February focused on the Patient-Driven Groupings Model (PDGM). That doesn’t mean the home health industry has lost the attention of Congress when it comes to PDGM and future payment, however. Kentucky […]

Home Health Continues to Gain Steam Despite Projections of Down Admissions

Despite expectations that home health admissions in the U.S. would drop in Q3 2018, both home health admissions and utilization continued to increase slightly quarter-over-quarter. Meanwhile, Centers for Medicare & Medicaid Services (CMS) data shows hospice utilization rose to record-breaking levels in the third quarter of 2018, while hospice admission growth declined slightly. The findings […]

Letter to the Editor: Amedisys CEO Paul Kusserow Pushes Back on Improper Payment Reports

Your article, “CMS Made $3.2 Billion in Improper Home Health Payments in 2018,” deserves a headline that draws readers’ attention to the real story here. Only in the next-to-last sentence does the piece mention the most telling data point — namely, that improper home health payments “plummeted dramatically” between 2015 and 2018 from 59% of […]

Home Care Providers Look Ahead as Medicare Advantage Evolution Continues

Home care providers slow to chase Medicare Advantage business opportunities may now be motivated to speed up their pursuits. Last week, the Centers for Medicare & Medicaid Services (CMS) announced it was broadening the range of supplemental benefits Medicare Advantage (MA) plans can offer in 2020. Starting next year, health care policymakers will allow MA […]

CMS Finalizes In-Home Medicare Advantage Telehealth Policies

The Centers for Medicare & Medicaid Services (CMS) announced Friday that the agency has finalized a set of policies designed to expand the use of telehealth benefits under the Medicare Advantage program. Originally proposed in October 2018 for the 2020 plan year, the new policies from CMS are meant to expand access to telehealth services […]