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…

NAHC to CMS: Roll Back 2020 Rate Adjustment Based on Faulty Prediction of HHA Behavior

The National Association for Home Care & Hospice (NAHC) urged the Centers for Medicare & Medicaid Services (CMS) to roll back the 2020 rate adjustment CMS instituted based on a prediction of how home health agencies (HHA) would behave that has not materialized. That recommendation, and several more, are part of NAHC’s formal comments to…

NAHC Analysis of the CY 2021 Home Health Proposed Rule

CY 2021 Home Health Proposed Rule Addresses Payment Rates, Telehealth, Quality Program and Home Infusion Therapy   Late this afternoon the preview of the CY 2021 home health proposed rule, Medicare and Medicaid Programs; CY 2021 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Home Infusion Therapy Services Requirements, was…

CMS Issues New G-Codes and Other Claims Processing Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 11721, two new G-codes to indicate on home health (HH) claims when maintenance therapy is provided by a therapy assistant. The CR also provides various clarifying changes to the Medicare Claims Processing Manual, chapter 10, in order to better reflect the policies…

Master the New Home Health Payment System at the 2020 PDGM Virtual Summits

Key insights and lessons learned from the top experts in home health care REGISTER NOW The current COVID-19 pandemic is demonstrating that more than ever quality care in the home is the future of American health care. Home health agencies are busier than ever and facing greater changes than ever. A new payment system is…