Home health providers are under more pressure today than arguably ever before. The immediate battle remains the Patient-Driven Groupings Model (PDGM), which could pose an 8.01% cut to providers if its assumption-based behavior adjustments aren’t addressed through Congressional action. But there are plenty of smaller skirmishes taking place in the background as well, according to […]
When it comes to the Patient-Driven Groupings Model (PDGM) and the impact the overhaul will have on the home health industry in 2020, outlook largely varies depending on who you talk to. On one hand, some industry insiders have told Home Health Care News that PDGM — mandated to be budget neutral by Congress — […]
The Review Choice Demonstration (RCD) is expanding. The Centers for Medicare & Medicaid Services (CMS) announced Monday that home health providers in Ohio will be next in line for RCD, a revived version of the failed Pre-Claim Review Demonstration (PCRD) meant to combat improper billing. Home health providers in Illinois — the only state with […]
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 […]
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 […]
In a scathing speech criticizing over-involvement of government in health care, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma praised Medicare Advantage (MA) as a bright spot. Specifically, she pointed to the competitive nature of the program as a driver of its success. “Don’t get me wrong: There are a lot of successes […]
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 […]
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 […]
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, […]
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 […]
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