Welcome to the HealthPRO® Heritage Blog

Coding for Success in PDGM

Posted on: May 14, 2019

Coding will be instrumental to your agency’s success under PDGM. Performing an audit of your coding practices now will provide the opportunity to educate your staff on accurate and cohesive coding guidelines and targeted aspects of the OASIS to ensure you are prioritizing both patient needs and accurate reimbursement. 

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Tags: PDGM, CMS Update 2019, Patient-Driven Grouping Model

Ticket to Ride: OASIS Will Drive Success Under PDGM

Posted on: April 30, 2019

Accurate OASIS coding has always been important, but with PDGM on the horizon, our ability to master the OASIS will be imperative! After all, accurate OASIS coding will directly impact an agency’s ability to achieve optimal outcomes and support reimbursement in today’s and tomorrow’s world.

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Tags: Home Health, PDGM, CMS Update 2019, Patient-Driven Grouping Model, PrepareExecuteSucceed, OASIS

Get Ready for PDGM

Posted on: April 25, 2019

Implementation of the new case-mix classification model, the Patient Driven Grouping Model (PDGM), on January 1, 2020 will bring BIG changes to the home health profession! HealthPRO® Heritage at Home is ready to help you start preparing TODAY for the most dramatic Medicare reimbursement change since PPS.

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Tags: Home Health, PDGM, CMS Update 2019, Revenue, Patient-Driven Grouping Model, PrepareExecuteSucceed, OASIS

Under PDGM: Revenue Cycle Matters

Posted on: April 15, 2019

PDGM implementation is a mere 38 weeks away, bringing significant changes in episode length (60 to 30 days), resultant billing processes, revenue cycle, and ultimately, cash flow. While certification periods will continue to be 60 days in duration, reimbursement will be broken into 30-day payment periods. As such, billing will have to be processed for each 30-day payment period including Requests for Anticipated Payment (RAPs) and final claims. This will likely result in a substantial increase in claims volume in addition to an interruption in cash flow. Specifically, agencies will experience a cash flow “crunch” during the first few months of implementation as the conversion from 60-day to 30-day payments is realized with a leveling off after the initial impact and conversion.

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Tags: Home Health, PDGM, Revenue, Patient-Driven Grouping Model, PrepareExecuteSucceed, Episode Length of Stay, ELOS

PDPM & PDGM: Let's Break Down the Confusion...Pt 2

Posted on: July 25, 2018

If the 2019 proposed rule is finalized, which we anticipate is likely, it will cement the shift in Medicare’s payment system from a prospective payment system to value based purchasing model.  With these mega changes it can feel like a daunting task to provide clinical excellence while maintaining a profit, thus it will be paramount that detailed analysis and strategies be developed to ensure that we keep patient care as our number one priority.

Following a thorough review of the 599-page “Proposed Rule”, HealthPRO® Heritage experts offer the following highlights on the PDGM section of the rule:

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Tags: PDGM, CMS Update 2019, Patient-Driven Grouping Model

PDPM & PDGM: Let's Break Down the Confusion...Pt 1

Posted on: July 12, 2018

On Monday, July 2, 2018, Centers for Medicare and Medicaid Services (CMS) released the 2019 Proposed Rule. Our industry has been anxiously awaiting this announcement since the introduction of “Home Health Groupings Model,” or HHGM in July 2017.

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Tags: Patient-Driven Payment Model, PDPM, PDGM, CMS Update 2019, Patient-Driven Grouping Model