The success of The Health Group, LLC is the result of quality service by experienced professionals in combination with our network of other professionals across the country.
PDGM is Coming
Effective January 1, 2020, Medicare home health reimbursement will be made using the Patient-Drive Grouping Model (“PDGM”). Some of the changes made by PDGM to existing PPS reimbursement are as follows:
New payment episode timings: PDGM will break up the standard 60-day episode of care into one of two 30-day periods. That means 30-day periods will be implemented as a basis for payment vs. the 60-day periods used now. Each 30-day period is grouped into one of 12 clinical categories based on the patient’s main diagnosis.
Payment groupings: PDGM will increase the number of payment groupings and unique case-mix potential from 153 to 432. PPS allowed for 153 combinations, but with PDGM each 30-day period can be categorized into one of 432 case-mix groups.
Elimination of therapy thresholds: PDGM will eliminate therapy thresholds as a primary determinant of reimbursement, so therapy visits will no longer determine reimbursement. The number of therapy visits will no longer impact the case-mix weight.
OASIS assessments will remain on a 60-day cycle, but there will be two payment periods within that cycle instead of one. Based on an OASIS assessment, new 30-day periods will be categorized according to five subgroups.
Low Utilization Payment Adjustments (LUPAs): LUPAs will undergo a major change, as each Home Health Resource Group (HHRG) will have its own LUPA visit threshold (2-6 visits) and the LUPA count will reset every 30-day payment periods.
Cost Reporting Changes and Rate Impact
Hospice Cost Reports – CMS has released Transmittal 3 which only increases the requirements of the Hospice Cost & Data Report which was issued at the end of 2014. Now, CMS has released the proposed rule regarding hospice payment rates to be effective October 1, 2019. The hospice payment rates have been substantially modified as a result of the proposed rebasing. This rebasing is primarily the result of cost report submissions. The accuracy of the Hospice Cost & Data Report has never been more important.
Home Health Agency Cost Reports – CMS has released a new Home Health Agency Cost Report which is effective for cost reporting years ended on or after December 31, 2019. The new cost report requires substantial changes in capturing costs and statistics. Cost report data will impact PDGM reimbursement in future years; accordingly, the new report must be taken seriously by all home health agencies.
The Hospice Cost Report will be extensively covered at our upcoming educational program scheduled for September 9-10, 2019 at the Hotel Monteleone in New Orleans, Louisiana. Program and registration information is available here.
2019 Hospice Educational Program
The Health Group, LLC has scheduled the 2019 Hospice Financial Management Academy for September 9-10, 2019 at the Hotel Monteleone in New Orleans, Louisiana. The timing of the program is perfect given the many changes coming for hospice. The program will provide extensive coverage of key issues of the day for hospices. The agenda and registration information is available here. Topics that will be covered include:
- Understanding the implications of the rebased hospice payment rates and accurate Hospice Cost Report preparation to appropriately influence hospice payment rates going forward. These changes are scheduled to be effective October 1, 2019.
- Medicare enrollment changes now scheduled for release on March 1, 2020.
- Hospice CAP Update including the impact of rebased reimbursement rates and changes relating to Extended Repayment Schedules (“ERS”).
- Accounting and Tax Update for healthcare providers (what is new and important).
- Managing claim reviews and denials for hospice providers.
The professionals at The Health Group, LLC have been providing financial and administrative educational programming to healthcare providers since 1993. The Health Group, LLC is a registered sponsor on the National Registry of CPE Sponsors.