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 […]

CMS Finalizes $340 Million Increase to Hospice Payments in 2019

The Centers for Medicare & Medicaid Services (CMS) has issued the final rule updating the fiscal year 2019 Medicare payment rates for hospice providers. As the agency proposed in April, hospices will see an increase of $340 million or 1.8% in their payments in fiscal year 2019, an increase of 1% from the last fiscal year. […]

Providers Side with MedPAC on Changes to Home Health Referral Rules

Hospital discharge planners should have more leeway in how they educate and inform patients about post-acute care options, perhaps making star ratings a more important part of the conversation, home health providers believe. But it’s a change that would need to be handled carefully to prevent favoritism or abuse in how referrals are made, they caution. […]

CMS Proposes Two Changes to Home Health Star Ratings Algorithm

One measure behind home health quality of patient care star ratings may be on its way out, but another is poised to take its place. The Medicare Learning Network, an education and outreach arm of the Centers for Medicare & Medicaid Services (CMS), outlined two recommended changes to quality of patient care star rating methodology […]

Home Health Ready to Fight Pre-Claim Review’s Dreaded Return

Stakeholders throughout the home health industry are gearing up for another battle over Pre-Claim Review Demonstration (PCRD), a controversial Centers for Medicare & Medicaid Services (CMS) initiative aimed at reducing fraud and improper billing. PCRD asks providers to send in claims earlier in the care process to ensure they are meeting requirements. In August 2016, CMS rolled out […]

Greater Proportion of Home Health Agencies Earn 5-Star Rating

About 5% of U.S. home health agencies earned a 5-star rating for quality of patient care in the latest update to the Home Health Compare website, which occurred on April 11. That’s an uptick from 4% as of January 2018. The percentage of 4.5-star agencies also increased in that time period, from 10% to 12%, […]

Home Care Entrepreneur Boehler to Lead CMS Innovation Center

Adam Boehler, an entrepreneur who started home-based care company Landmark Health, has been tapped as the new director of the Center for Medicare and Medicaid Innovation (CMMI). The appointment puts someone with home care expertise in charge of the office spearheading new Medicare payment and delivery models, such as bundled payment programs and accountable care […]

Hospice Compare Now Includes Consumer Survey Data

The Centers for Medicare & Medicaid Services (CMS) has for the first time released the results of the CAHPS Hospice Survey on Hospice Compare. The survey—the Consumer Assessment of Healthcare Providers and Systems (CAHPS)—asks family members or friends who cared for a patient who died under hospice about their experience with the provider. The survey […]