• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

InFront on the Workforce

Long-term and post-acute care publication

Subscribe | Events | Advertise | Contact Us

  • Facebook
  • LinkedIn
  • Twitter

  • HOME
  • ABOUT
    • Who We Are & What We Do
    • The Vision
    • Readership
  • RESOURCES
    • Important Links
  • Retention & Engagement
  • Culture & Leadership
  • Regulatory
  • Technology
  • Industry Trends

CMS Finalizes PDGM to Revamp Home Healthcare Payments

By Joanne Kaldy / November 22, 2018

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.”

Related Posts

  • What Assisted Living Providers Want From Home Care Partners
  • Little Wage Growth for Home Care Workers in Last Decade
  • (10/11) Social Security Payments to Increase in 2019 – Social Security Administration
  • (10/22) LTC Physical Therapists Get 2.39% Pay Bump, Though Home Health, Hospitals Give Larger Raises – McKnight’s Long-Term Care News

Categories: Regulatory / Tags: Featured, Latest Articles, More Articles

Primary Sidebar

AROUND THE WEB

Items of interest from across the web.

  • (6/27) Employers Prepare Benefits and Policy Responses to Abortion Ruling, SHRM Survey Finds – SHRM
  • (6/27) Staffing Trends Study Could Create Roadmap for Helping Long-Term Care Industry – McKnights
  • (6/24) Former CMS Administrator Predicts Dire Near-Term Outlook for Home Health Industry – Home Health Care News
  • (6/24) Number of the Day: Skyrocketing Turnover – HR Executive
  • (6/23) ProMedica Senior Care President: Nursing Home Operators Need to ‘Embrace the Disruption’ – Skilled Nursing News
  • (6/23) How Employers Can Avoid ‘Rainbow Washing’ — SHRM
  • (6/22) Fine-Tune Compensation Strategies to Keep Workers On Board – SHRM
  • (6/22) Starting From Within: How Nursing Home Operators Can Tackle Fewer Applicants, Draining Turnover – Skilled Nursing News
  • (6/21) This Missing Question Explains Why Many Employee Goals Are Useless — TLNT

 

 

 

View All

CONTACT INFO

Publisher: CC Andrews
440.638.6990
Editor: Joanne Kaldy

PO Box 360727
Cleveland, OH 44136

CATEGORIES

  • CULTURE & LEADERSHIP
  • RETENTION & ENGAGEMENT
  • REGULATORY
  • TECHNOLOGY
  • TRENDS IN THE INDUSTRY

Copyright © 2022 - InFrontWorkforce.com. All rights reserved.