Ohio Home Health Agencies Are Next in Line for the Review Choice Demonstration

The Review Choice Demonstration (RCD) is expanding. The Centers for Medicare & Medicaid Services (CMS) announced Monday that home health providers in Ohio will be next in line for RCD, a revived version of the failed Pre-Claim Review Demonstration (PCRD) meant to combat improper billing. Home health providers in Illinois — the only state with […]

OIG Calls for Additional Oversight of Home Health, Personal Care Service Providers

In a new report released Monday, the U.S. Department of Health and Human Services Office of Inspector General (OIG) highlighted dozens of its unimplemented recommendations for reducing fraud, waste and abuse throughout the Medicare and Medicaid systems. Many of the recommendations were tied to home health, hospice and personal care services, in addition to how […]

CMS Finding New Ways to Penalize Home Health Providers

The Centers for Medicare & Medicaid Services (CMS) is finding new ways to penalize home health providers. In its proposed payment rule for 2020 released last week, CMS floated the idea of phasing out pre-payments for home health services starting in 2020, killing them completely by the following year. Currently, home health providers can receive […]

[Updated] CMS Proposes Elimination of RAPs, $250 Million Medicare Payment Increase

The Centers for Medicare & Medicaid Services (CMS) is moving forward with many of the provisions originally included in the Patient-Driven Groupings Model (PDGM) while also proposing to implement a new home infusion benefit, eliminate home health pre-payments and make Value-Based Purchasing Model (VBPM) performance data public. CMS detailed its plan for PDGM and other […]

Home-Based Care Ally Adam Boehler to Leave CMMI

A key ally for home health providers and a major proponent of value-based care may be leaving his federal post. The Trump administration revealed late Wednesday it has nominated Adam Boehler — director of the Center for Medicare & Medicaid Innovation (CMMI) and a senior adviser to the secretary of the U.S. Department of Health […]

Lawmakers to Verma: Time to Ditch PDGM’s Behavioral Assumptions

The flood of home health support from Congress on the Patient-Driven Groupings Model (PDGM) front continues. On July 2, a bipartisan, bicameral group of lawmakers sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, urging the agency’s leader to revisit certain widely opposed provisions of PDGM during CMS’s annual rulemaking […]

Why Home Health Therapy Contractor Aegis Isn’t Stressing About PDGM

Among its many changes, the Patient-Driven Groupings Model (PDGM) aims to completely refocus how home health providers are paid for the therapy services they deliver, mainly by moving away from visit volume as the determining factor in calculating reimbursement. When the Centers for Medicare & Medicaid Services (CMS) first proposed PDGM in July 2018, some […]

CMS: No ‘Secret List’ of Troubled Home Health Agencies

Earlier this week, a bipartisan pair of U.S. senators released a “secret list” of nursing homes under consideration for placement on the federal government’s roster of properties with serious quality issues. Maintained by the Centers for Medicare & Medicaid Services (CMS), the list features more than 400 nursing homes that are “candidates” for the Special […]