Welcome to the HealthPRO® Heritage Blog

With PDGM less than 8 weeks away, it is imperative that we begin finalizing the details. One of the most important components under the new payment model is to receive an accurate primary diagnosis that falls into one of the 12 clinical groupings. We understand how critical it is to your revenue cycle to get it right the first time. And though the home health industry and our referral sources are clear that questionable encounters can no longer be used, they are tired of hearing what they CANNOT order. They are hungry to find out what IS available on the menu from which to choose, so HealthPRO® Heritage at Home developed resources for your referral sources to easily identify the top diagnoses per clinical grouping [download below].

We all survived the PDPM transition on October 1. Now what?

As the dust settles, SNFs may be wrestling with an important question: How will the industry define and measure success under PDPM & Beyond?

October 31, 2019 – As expected, CMS finalized the significant payment model change for Home Health services starting in 2020. The Patient-Driven Groupings Model (PDGM) will start with any new patient episodes on or after 01/01/2020.

With only 11 weeks left until the January 1, 2020 implementation date of PDGM, we are now into a time for final preparations. After months of education to help home health agencies prepare, execute, and succeed, we now summarize and offer what we believe will be the Four Pillars of Success under PDGM.  

Gut-Check Survey Results + Feedback from the PDPM Front Line
HealthPRO® Heritage launched a survey – “PDPM Gut-Check” – to capture how the industry is feeling about the new reimbursement system.  Here’s what you and your peers had to say.

With PDGM on the horizon in less than 100 days, agencies are hearing more chatter around three key areas: Face-to-Face (F2F) Encounters, Targeted Probe and Educate (TPE), and Review Choice Demonstration (RCD). All three will affect reimbursement as agencies will need to utilize best practices. Agencies must thoroughly understand the requirements of each process to sustain viability going forward.

Now is the time for our industry to over-communicate!  Put your two cents in, and learn more about what your peers are thinking, feeling, and what’s keeping them up at night, too. 

LUPA (Low Utilization Payment Adjustment), the 4 letter word that we have all been trying to avoid under the current PPS system.  Just when we thought we had it under control, CMS has decided to add a whole other level of complexity with PDGM.  The challenge to managing LUPA’s under PDGM will be two-fold; a “moving LUPA” for each 30-day payment, and the need to meticulously manage visits within each of those 30-day windows to avoid that LUPA. 

With PDGM a mere 3 months away, agencies need to focus not only on preparing for the biggest change to Medicare reimbursement in 20 years, but also be diligent in developing their 2020 marketing plan to ensure successful growth. Home care is uniquely positioned as one of the lowest cost options for skilled care and is available to patients who adhere to the home bound status. One aspect that does not change with payment reform is the ongoing need for quality and value based care delivered in the home.

Recent CMS initiatives have created an interesting dynamic in the post-acute care industry:  Providers across the care continuum are being incentivized to form strategic partnerships and hold each other accountable for delivering efficient, enhanced patient care.