Tag: PDGM

CMS puts more weight on behavioral assumptions, but increases payments by 1.3%

CMS is seeking to reduce agency payments even more than expected to account for assumed behavioral changes agencies will make as part of the Jan. 1, 2020, implementation of the Patient-Driven Groupings Model (PDGM). Even with the shift from 6.42% to an 8.01% reduction in agencies’ payments due to behavioral changes, the home health industry […]

Proposed rule: CMS moving forward with PDGM in 2020

CMS is staying true to plans to implement a new payment model. The 2020 PPS proposed rule, which was posted to the Federal Register July 11, reinforces the plan to implement the Patient-Driven Groupings Model (PDGM) beginning on or after Jan. 1, 2020. The model will move from 60-day episodes to 30-day payment periods. While […]

Proposed bill would innovate use of home health services

The Home Health Payment Innovation Act of 2019, H.R. 2573, would preserve Medicare recipients’ access to home health services and provide a pathway for innovative approaches to using these services. According to LeadingAge, which supports the bill, H.R. 2573 would prevent unwarranted payment rate cuts of Patient Driven Groupings Model (PDGM) by basing any behavioral […]

Create a clinical documentation improvement program to achieve PDGM success

Strong documentation is key in home health, and implementation of the Patient-Driven Groupings Model (PDGM) will add a new level of urgency to improvement in this area, industry experts contend. Coding will play a major role in how agencies are paid under PDGM, from determining the clinical group to whether a patient qualifies for a […]

HIPPS groups with the lowest and highest case-mix weights under PDGM

The following 15 HIPPS groups will have the lowest and highest case-mix weights under PDGM, according to the 2019 PPS final rule. The following 15 HIPPS groups will have the lowest case-mix weights under PDGM, according to the 2019 PPS final rule. HIPPS Clinical group and functional level Timing and admission source Comorbidity adjustment Weight 3GA11 […]

LUPAs remain a complicated area under PDGM

Source: Home Health Line Despite the fact that payment episodes under the Patient-Driven Groupings Model (PDGM) will last 30 days instead of 60, LUPAs still will occur under the new payment model CMS is creating beginning on or after Jan. 1, 2020. Unlike with the PPS, where a LUPA involves four or fewer visits during […]

PPS final rule increases agencies’ payments for 2019, finalizes PDGM

CMS has finalized a plan to launch a budget-neutral payment model for home health that utilizes 30-day payment periods and stops using the number of therapy visits to determine payment. That’s according to the 2019 PPS final rule posted Oct. 31 on the Federal Register website. The Patient-Driven Groupings Model (PDGM) will launch “on or […]

CMS forum provides noteworthy updates about HEART and quality reporting training

Brought to you by Home Health Line. To address concerns raised during pilot testing for its planned comprehensive hospice assessment tool, CMS has decided to delay further testing phases. But CMS is working diligently to retool the Hospice Evaluation and Assessment Reporting Tool (HEART) and plans to hold quarterly special open door forums beginning in […]