Home Health LUPA Challenges Continue as Pandemic Subsides

The frequency of low-utilization payment adjustments (LUPAs) increased for many home health providers in the first year of the Patient-Driven Groupings Model (PDGM), which coincided with the COVID-19 crisis. In part, that’s because there are far more LUPA variables to keep track of under the new payment model. At times, increases were also linked to […]

CMS Could Target LUPAs, Functional Impairment in Future PDGM Adjustments

Despite the once-in-a-generation COVID-19 pandemic, the home health industry’s transition to the Patient-Driven Groupings Model (PDGM) was pretty seamless. Looking into the not-too-distant future, the U.S. Centers for Medicare & Medicaid Services (CMS) will now likely attempt to make modest tweaks to a handful of key areas, payment experts believe. The agency will do so […]

Home Health Agencies Continue to Struggle with Orders Tracking

The switch from the Prospective Payment System (PPS) to the Patient-Driven Groupings Model (PDGM) in 2020 has posed a slew of challenges for home health providers. Orders tracking is one of them. The slicing of billing periods from 60 to 30 days has raised the stakes when it comes to obtaining signed orders. During the […]

Debunking Common PDGM Primary Diagnosis Myths

In order for home health providers to see reimbursement success, they need to be able to separate myths from facts when it comes to the Patient-Driven Groupings Model (PDGM). But one specific point of confusion has been primary diagnosis clinical groups. “There are a lot of rumors and myths floating around out there,” Robbi D. […]

Assisted Living Facilities Still Restricting Home Health Providers

Home health providers have been on the front lines of the COVID-19 crisis since its outset, yet a primary concern remains being left behind by legislators, whether that’s on a state or federal level. Reimbursement for telehealth services is still on the forefront of everyone’s minds. But there are less-covered issues that haunt providers as […]

Elara Caring Targets Physicians as Home Health Providers Rethink Referrals

In the build-up to 2020 and the Patient-Driven Groupings Model (PDGM), many home health providers began shifting their referral strategies to focus more on hospitals, skilled nursing facilities (SNFs) and other institutional sources. Generally, providers realized that patients coming from such settings likely meant more Medicare dollars under PDGM, especially when patients were also classified […]

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 […]