Artificial Intelligence Holds Promise in Detecting Home Health Medicare Fraud

A study on artificial intelligence (AI) suggests the technology holds promise for detecting Medicare fraud within home health and hospice. However, leaders within the industry say a measured approach should be taken, given potential shortcomings and pitfalls related to AI. The research team at Florida Atlantic University programmed computers to predict, classify and flag potentially […]

PDGM, CoPs Put Home Health Providers in Rough Regulatory Waters

For in-home care providers, navigating the regulatory waters can often be challenging. Being flexible and monitoring the constant waves of change are key to staying afloat. The Patient-Driven Groupings Model (PDGM) from the Centers for Medicare & Medicaid Services (CMS) and the finalized interpretive guidelines for home health Conditions of Participation (COPs) are two recent regulatory items that are causing industry stakeholders […]

House Bill Directs CMS to Issue Long-Delayed PACE Rule

Long-awaited final rules for Programs for All-Inclusive Care for the Elderly (PACE) could be coming this year, thanks to a bill working its way through the House of Representatives. PACE programs utilize mixed funds from Medicare, Medicaid and private sources to offer a full range of services and support to individuals who are at least […]

PDGM Likely to Shake Up Patient Populations for Home Health Agencies

The latest proposed payment model from the Centers for Medicare & Medicaid Services (CMS) could shake up how the home health industry treats referrals that come from institutional settings versus community-based ones. As a result of changes under the Patient-Driven Groupings Model (PDGM), agencies may start trying to form closer relationships with hospitals or skilled nursing […]

Home Health Wields Political Clout to Shape Policy

Vowing to flex political muscle its built in the nation’s capital and throughout the country, home health providers and advocates are prepared to fight a new proposal to bring back the controversial pre-claim review. This is not an empty threat, a Home Health Care News (HHCN) review of lobbying data and recent advocacy efforts suggests. Over […]

Home Health Ready to Fight Pre-Claim Review’s Dreaded Return

Stakeholders throughout the home health industry are gearing up for another battle over Pre-Claim Review Demonstration (PCRD), a controversial Centers for Medicare & Medicaid Services (CMS) initiative aimed at reducing fraud and improper billing. PCRD asks providers to send in claims earlier in the care process to ensure they are meeting requirements. In August 2016, CMS rolled out […]

ElevatingHome, VNAA Reaffirm Goals as CEO Moorhead Steps Down

Tracey Moorhead has resigned as president and CEO of the Visiting Nurse Associations of America (VNAA) and ElevatingHome. Danielle Pierotti, RN, PhD, CENP, vice president of quality and research, has stepped into the role of interim CEO.   VNAA is an industry association and advocacy group for home-based care with a membership base of not-for-profit […]

CMS to Home Health: ‘Sky is Not Falling’ Over Lack of CoP Guidelines

While the spotlight across the home health care industry has recently shined on the upcoming payment reform, providers are still grappling with new requirements that went into effect in January—the Conditions of Participation (CoPs). The new CoPs—the standards that agencies must follow to participate in Medicare—were the first update to the requirements in decades. And […]

Home Health Executives Interpret Payment Reform Proposal

When the Bipartisan Budget Act of 2018 was signed into law in February, a new home health payment system was back on the table. However, language of the bill left some unanswered questions about what the new model will look like. Namely, the legislation outlined “30-day units of service,” which does not make clear if […]