Addus Exec: CMS’s Dual-Eligibles Move Encouraging for In-Home Care Providers

The Centers for Medicare & Medicaid Services (CMS) announced plans Wednesday to expand coverage options for Americans who qualify for both Medicare and Medicaid, giving states the freedom to develop their own programs for dual-eligible beneficiaries. While the directive doesn’t outline specific opportunities for home-based care providers, the move is still encouraging for the industry, […]

Credit, Billing Staff Are Keys to a Smooth Financial Transition into PDGM

When the Patient-Driven Groupings Model (PDGM) takes effect Jan. 1, home health care billing processes will become significantly more complicated. The new model revolutionizes the way agencies are reimbursed, cutting payment periods in half and requiring more detailed claims, among other changes. As a result, PDGM will likely put financial strain on even the most […]

Why Home Health Providers Should View PDGM as a Patient-Classification Model

Understandably, home health providers typically view the Patient-Driven Groupings Model (PDGM) first and foremost as a payment overhaul — the most significant in nearly two decades. But with the right perspective, PDGM can also be leveraged to help drive change, strengthen care planning and improve patient quality outcomes. That’s something home health providers would be […]

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 ultimately […]

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 […]