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…

New NAHC Webinar: PDGM and Data Analytics

NAHC will present a new webinar, Data Analytics, on Wednesday, March 11, 2020 from 1:00 to 2:30 PM Eastern Time. This new webinar is the fifth in the six-part series, PDGM in Real Time. Real time data availability and early analysis of the key performance indicators in PDGM are important and essential ingredients to early success…

New NAHC PDGM Webinar: Clinical Management of Patient Episode

NAHC will present a new webinar, Clinical Management of Patient Episode, on Wednesday, March 11, 2020 from 1:00 to 2:30 PM Eastern Time. This new webinar is the fifth in the six-part series, PDGM in Real Time. This webinar will explain current issues agencies are experiencing including utilization and visit planning, missed visits, interdisciplinary communication, and…

New NAHC Webinar: Therapy in PDGM

NAHC will present a new webinar, Therapy in PDGM, on Wednesday, March 4, 2020 from 1:00 to 2:30 PM Eastern Time. This new webinar is the fourth in the six-part series, PDGM in Real Time. This webinar will discuss current challenges agencies may be experiencing with providing therapy under the PDGM model. We will also…

CMS Open Door Forum: Updates on PDGM, Claims Processing Issues, Quality & More

On February 26, the Centers for Medicare & Medicaid Services (CMS) held its monthly Home Health, Hospice and DME Open Door Forum (ODF).  Following are updates related to the home health agency portion of the call. PDGM CMS reviewed two MedLearn (MLN) Matters articles recently issued that provide information and education on the Patient Driven…