OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services

Hospitals improperly coding for post-discharge services contribute to hundreds of millions of dollars in Medicare overpayments. And the majority of incorrect payments are often related to home health services. That’s according to a new audit report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG). The purpose of the OIG […]

CMS: True Telehealth Change Will Require Congressional Action

The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would make certain COVID-19-related telehealth flexibilities introduced over the past few months permanent for Medicare beneficiaries. The move comes in conjunction with an executive order from President Trump to improve rural and telehealth access.  While CMS’s proposed rule potentially paves the […]

Home-Based Medical Care Can Reduce Hospitalizations and Lower Costs — But It’s Still Underutilized

While home-based medical care has been shown to reduce hospitalization rates and lower costs for both homebound and non-homebound populations alike, it continues to be drastically underutilized in the current health care ecosystem. As a result, there are millions of older Americans — especially those living in rural areas — who are going without the […]

What Home Health Providers Need to Know Before a Medicare Part B Expansion

Home health providers that are looking to tap into new revenue streams may turn to more Medicare Part B services moving forward. But these companies need to have a firm understanding of the reimbursement rules in order for their efforts to be fruitful. The Patient-Driven Groupings Model (PDGM), industry consolidation and the Review Choice Demonstration […]

Humana Helps Fast-Track In-Home Primary Care Company Heal’s Growth with $100M Investment

Health and well-being company Humana Inc. (NYSE: HUM) has spent the past few years adding to its health care services portfolio while aggressively investing around a home-based care strategy. The Louisville, Kentucky-based company has now revealed its latest step in that direction. On Wednesday, Humana announced a wide-ranging strategic partnership with Heal, the in-home primary […]

Early Data Shows PDGM’s Regional Winners, Losers 

The impact of the Patient-Driven Groupings Model (PDGM) doesn’t appear to be universal. In fact, each home health care agency’s performance under the model seems to depend on a few somewhat uncontrollable factors, new PDGM data suggests. “CMS created a model that was based on all claims nationally, but depending on where you are and […]

Emergency Responders, In-Home Care Providers Seek Collaboration — Not Competition

As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home. Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space — have always provided some degree of care in the home […]

The Number of Medicare-Certified Home Health Agencies Is Dwindling

The number of Medicare-certified home health agencies in the United States is dwindling — and it’s a trend that started long before the Patient-Driven Groupings Model (PDGM) kicked in. From 2018 to 2019, the number of home health agencies dropped by about 3.6%, a decrease of 427 individual providers, according the Medicare Payment Advisory Commission […]