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 […]

How Telehealth Can Solve Home Health Agencies’ PDGM Therapy Problems

One of the most anxiously awaited aspects of the Patient-Driven Groupings Model (PDGM) is the elimination of therapy visit volume as a determining factor in calculating reimbursements. Despite reassurance from industry leaders that PDGM isn’t a ‘death knell’ for therapy services, therapy-heavy agencies will have to become more cost effective to ensure they don’t take […]

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 […]

LHC Group CEO: MedPAC ‘Off on Some Island’

In its latest report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended cutting the home health reimbursement rate by 5% in 2020 while continuing its push for a unified, site-neutral payment system for all post-acute care providers. Those recommendations are short-sighted and fail to recognize the value that home health care providers have created […]

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 […]

MedPAC Pushes 5% Home Health Payment Cut, Says Program Integrity Remains a Challenge

The Medicare Payment Advisory Commission (MedPAC) submitted its Medicare payment policy report to Congress on Friday, again recommending a 5% home health payment rate reduction for the coming year and maintaining its view that program integrity remains problematic. MedPAC is required to report to Congress each March on the Medicare fee-for-service (FFS) payment systems, the […]

How to Handle a Home Health Audit, According to a CMS Auditor

If you operate a home health agency, Laura Long and her colleagues are probably the last people you want to hear from. Long is the Medicare operations lead at AdvanceMed, one of five unified program integrity contractors (UPICs) nationwide hired by the Centers for Medicare & Medicaid Services (CMS) to audit and investigation home health […]