Home Health Bankruptcies Likely to Rise After PDGM

Although a fairly common practice in the senior housing and skilled nursing worlds, home health providers as a group have largely avoided bankruptcy proceedings, partly thanks to a steady reimbursement landscape and increasing demand for services by older Americans hoping to age in place. If history serves as any guide, that’s likely to change under […]

CMS Picks Review Choice Demo Start Date, Releases New Details

The Centers for Medicare & Medicaid Services (CMS) has picked an official start date for its Review Choice Demonstration (RCD), an initiative meant to curb improper billing among home health providers. On Wednesday, CMS announced RCD will begin in Illinois on June 1. For home health providers operating in Illinois, that means all episodes of […]

CMS Adds More In-Home Care Services as Medicare Advantage Benefits for 2020

For the second year in a row, the Centers for Medicare and Medicaid Services (CMS) has widened the scope of supplemental benefits Medicare Advantage (MA) plans can offer, creating even more opportunities for home care providers to become partners in MA contracts. CMS is also giving the MA program a pay raise to help drive […]

CMS Launches AI Challenges for Predicting Unplanned Hospital, SNF Admissions 

The Centers for Medicare & Medicaid Services announced last week the launch of a three-stage challenge designed to encourage the use of artificial intelligence (AI) in health care. As part of the challenge, participants will be tasked with using AI to better predict unplanned hospital and skilled nursing facility admissions — already a key focus […]

CMS Made $3.2 Billion in Improper Home Health Payments in 2018

Despite increased oversight efforts, improper payments under Medicare and Medicaid are costing the federal government billions of dollars, a new report from the watchdog arm of Congress has found. And home health providers appear to be the root of the problem. In fiscal year 2018, improper Medicare fee-for-service (FFS) payments totaled $31.6 billion for all […]

Senator Susan Collins Takes Aim at PDGM’s Behavioral Assumptions

Home health providers and advocates have carefully worked to cultivate their political clout on Capitol Hill over the past few decades. Those efforts — paired with changing U.S. demographics, proven savings to the U.S. health care system and older adults overwhelmingly expressing their desire to age in place — have helped win the support of […]

Cash Flow, Timing and Other Practical FAQs About PDGM Answered

There are just nine months to go before the implementation of the Patient-Driven Groupings Model (PDGM), but many home health care agency owners and operators remain uncertain about what the looming payment overhaul will mean for them.   On a macro level, all home health agencies are waiting to find out if reimbursement changes will […]

Review Choice Demonstration Clears Hurdle, Likely Starting Soon

The Review Choice Demonstration (RCD) is likely right around the corner for Illinois home health providers. The Centers for Medicare & Medicaid Services (CMS) announced March 4 it had received Paperwork Reduction Act approval for RCD from the White House Office of Management and Budget (OMB). Since OMB approval, the agency has been finalizing the […]

Primary Diagnosis Changes Among PDGM’s Most Overlooked Aspects

The Patient-Driven Groupings Model (PDGM) is just nine months from taking the home health care industry by storm. By now, operators should have started preparing for the sweeping adjustments on tap for 2020 — but taking the right steps at the right time is crucial to ensuring success.   Among its high-level changes, PDGM removes […]