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 […]

Home Health Cash Flow Has Yet to Recover from Post-PDGM Dip

Even before the coronavirus hit, cash flow was poised to be a problem for home health providers in 2020. The Patient-Driven Groupings Model (PDGM) shortened home health billing periods from 60 days to 30, creating a cash flow crunch for agencies during their first few months under the new model, which took effect Jan. 1. […]

By the Numbers: Breaking Down Home Health LUPA Patterns

In the first three months of the year when home health agencies were adjusting to the Patient-Driven Groupings Model (PDGM), the national low-utilization payment adjustment (LUPA) rate hit 9.5%. LUPA rates reached their height in March, when the coronavirus took the U.S. by storm. Those were just a couple key takeaways from a BlackTree Healthcare […]

Home Health Care Trends Starting to Emerge After Q1 of PDGM

Medicare-certified home health agencies have now had over a full quarter to adapt to the Patient-Driven Groupings Model (PDGM). While comprehensive claims data is still coming in, a few interesting patterns are already starting to emerge. Among the high-level takeaways, case mixes appeared to be higher during the first quarter than what the U.S. Centers […]

‘Innovators Will Succeed’: Why Home-Based Care Agencies Need to Start Adapting to the New Normal

Both during and after the COVID-19 crisis, success will favor the innovators. Providers that can adjust their business operations accordingly and keep up with the sweeping regulatory changes will have a massive advantage moving forward. Conversely, those resistant to the new, post-coronavirus normal run the risk of being left behind. “The easy prediction is that […]

Home Health Agencies Conquering Fear of PDGM Boogeyman

The Patient-Driven Groupings Model (PDGM) was one of the largest concerns for the home health industry after it was finalized by the Centers for Medicare & Medicaid Services (CMS) in October 2019. But now that it has been implemented and agencies have faced their boogeyman, confidence under the new payment model is growing, industry insiders […]