Home health is the latest LTPAC sector to get a major face lift in coding, billing and payment models.
Skilled nursing isn’t the only sector dealing with major changes in how they code, bill and receive payment. The Centers for Medicare & Medicaid Services (CMS) passing its final version of the Patient-Driven Groupings Model (PDGM), is set to revamp the coding groups and payments for the home health sector.
Home health providers will need to pay close attention to retraining all coders, any employees involved in case-mix adjustment and even the company executives who may need to reconsider what types of services will be best for the organization under the new CMS rule.
The final rule includes several sweeping changes, including a new 30-day unit payment designed to reduce the incentive to provide more care than necessary and changes to case-mix adjustments across 432 categories. CMS predicts that the new model could boost payments to home health agencies by 2.2%–a whopping $420 million—in 2019 alone.
Yet many home health providers were against parts of the rule, especially the rule’s “behavioral adjustment” related to coding and Low Utilization Payment Adjustments (LUPAs). Specifically, the rule assumes that coders will revise their coding behaviors to focus on efficiencies while LUPAs have been revamped to allow different thresholds for different patient groups instead of the previous “four or fewer” catch-all.
“A lot of ink has been spilled the last few months on the impact of PDGM on the home health industry,” Keith Myers, CEO and Chair of LHC Group, one of the nation’s largest home health, hospice and personal care companies, told Home Healthcare News. But, he adds, “The smooth integration, in turn, enhances our strong organic growth, adds in new layers of additional growth, similar to what we’ve accomplished with our joint ventures, by bringing up quality to our standards and increasing margins. It enables us to keep our eye on the ball for new growth opportunities through market expansion, extension of our co- and tri-located service offerings, joint ventures and tuck-in acquisitions.”