NAHC Encourages HHA Participation in Research Study

The National Institutes of Health is funding a research project to be conducted by the University of Washington and the University of Pittsburgh to understand how PDGM and COVID-19 has impacted  home health agency operations. The study will explore home health agency administrators’ experiences of these events through one-on-one confidential phone interviews.  The National Association for…

The Financial & PDGM Expertise Your Agency Needs is at the NAHC Fall Forum

Home health and hospice finance has never been more complicated or more important. Changes to the payment system like PDGM, pre-claim review, Notice of Admission, the 30-day billing cycle, and the rise of Medicare Advantage have created new and daunting challenges to executives and financial managers. No agency can survive without understanding what these changes…

PDGM Under Scrutiny at MedPAC Meeting

Some Commissioners lament base payment rate The Medicare Payment Advisory Commission (MedPAC) met to discuss the development of a mandated report assessing the impact of the shift to the PDGM payment model for Medicare Home Health, and in particular the 30-day episode and the removal of therapy utilization in payment determinations. According to MedPAC staff,…

NAHC Comments to CMS Call for Important Changes to Proposed Rule

“It is highly unlikely that home healthcare delivery in 2022 will be anything comparable to care delivery in 2020.” – NAHC The National Association for Home Care & Hospice (NAHC) has filed comments to the Centers for Medicare & Medicaid Services (CMS) on the CY2022 proposed rule, calling for no substantial changes to the PDGM payment…

HHVBP Continues to Show Cost Savings and Quality Home Health Care

The Centers for Medicare & Medicaid Services (CMS) has released the fourth annual report on the Home Health Value Based Purchasing (HHVBP)Demonstration, which includes data from calendar year (CY) 2019. This data will impact payment adjustments for participating home health agencies (HHAs) for CY 2021. The most notable part of the report is the cumulative savings of…

CMS Issues Manual Instructions for the Home Health NOA

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12256, Replacing Home Health Requests for Anticipated Payment (RAPs) with the Notice of Admission (NOA). The CR updates multiple sections of the Chapter 10 of the Medicare Claims Processing Manual to reflect requirements for the Patient Driven Groupings Model such as adding “Notice of Admission” when applicable and replacing the phrase “60 day…

Common Working File Edit Causing Incorrect Payments on Some LUPA Claims

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12085 – Correction to Period Sequence Edits on Home Health Claims. The CR addresses an edit in the Common Working File that bypasses period of care sequencing on Low Utilization Payment Adjustment (LUPA) claims. Before the implementation of the Patient-Driven Groupings Model…

New PDGM Webinar: Lessons Learned from 2020

The National Association for Home Care & Hospice will present a new educational webinar, PDGM: Lessons Learned from 2020, on Tuesday, January 26, 2021 from 2:00-3:00pm Eastern. This webinar is free to NAHC members and non-members alike. REGISTER Among other things, 2020 brought historic change for home health agencies across the country. As the demand for in-home…

CMS Updates Home Health Claim Processing Instructions for Unsolicited Responses

The Centers for Medicare & Medicaid Services (CMS) recently updated the claims processing instructions for Medicare Administrative Contractors (MACs), including instructions for processing multiple unsolicited responses on the same home health claim. Prior to the implementation of PDGM (Patient Driven Groupings Model), there was no need for multiple unsolicited responses to be processed during the…

Members of Congress ask CMS to Eliminate Behavioral Rate Cut in PDGM

Senator Susan Collins (R-ME) and Rep. Vern Buchanan (R-FL)  have sent two separate letters to Administrator Seema Verma, asking the Centers for Medicare and Medicaid Services (CMS) to consider eliminating the behavioral assumption rate cut currently included in the Patient Driven Grouping Model (PDGM).  As part of the PDGM payment model, CMS included a 4.36…