Why Home Health Providers Will Need to ‘Spoon-Feed’ Physicians Under PDGM

The home health industry is right on the cusp of the Patient-Driven Groupings Model (PDGM) becoming the new normal. Among its changes, the payment overhaul gets rid of scores of previously acceptable primary diagnosis codes under the Prospective Payment System (PPS). In fact, PDGM has roughly 40% fewer acceptable codes compared to the current payment […]

Pre-Claim Tests Home Health, Physician Relationships

As Illinois home health agencies have grappled with numerous challenges imposed by the Medicare Pre-Claim Review (PCR) demonstration, making sure home health can work hand-in-hand with physicians has emerged as an acutely important issue. Under the PCR demonstration, agencies must submit claim documentation to a Medicare administrative contractor (MAC) for audit; affirmed claims may be submitted […]

Advocate Under Fire in Another Home Health Lawsuit

Home health workers are again filing suit against Advocate Health Care, as a group of home care nurses claim the company improperly exempted them from certain federal and state wage laws and therefore owes them overtime pay. Advocate is a faith-based, not-for-profit health system based in Downers Grove, Illinois. The company has one of the […]