Home Health Allies in Congress Tell CMS to Ensure PDGM Fairness

Two U.S. Senators and two Representatives have written a bipartisan letter to the Centers for Medicare & Medicaid Services (CMS), urging the government agency to craft a CY2023 home health payment proposed rule that ensures “payments under the Patient Driven Groupings Model (PDGM) are fair to providers and ensure patient access to high-quality care.” “A…

Supplemental Medical Review Contractor Home Health Project

In November, CMS’ Supplemental Medical Review Contractor (SMRC) posted a new project, 01-031 Home Health Notification of Medical Review. This is a post-payment review of claims for Medicare Home Health services billed on dates of service from January 1, 2020 through December 31, 2020 for bill types 032X and 034X.  Detailed specifics about the project…

CMS Finalizes Payment Rate Update to Home Health for 2022

NAHC webinar on the CY2022 Final Rule on Friday! Free for NAHC members! Learn more! Home health payment rates increased by 2.6% CMS does not increase or decrease behavioral adjustment 432 case mix weights recalibrated using 2020 data CMS refuses to continue the 5% cap on negative wage index changes HHVBP demonstration expansion nationwide delayed…

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…