Welcome to the HealthPRO® Heritage Blog

A common assumption among home health providers is that outsourcing rehab services is costly.  But a close look at the benefits of contracted therapy demonstrates a very different perspective. 

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].

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.

Over the course of the last several months we have pushed out education across multiple platforms on how HealthPRO® Heritage at Home can help you Prepare, Execute, and Succeed in PDGM. We are now into a time for final preparations  with only 11 weeks left until the January 1^st 2020 implementation date.  This blog highlights the four pillars of success under PDGM.  

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.

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.

Is your current therapy company or in-house therapy team equipped to help you prepare, execute and succeed under PDGM?

Five, ten, and fifteen years ago, the intake department was just that: Intake. Taking in the information given to them from a referral source and performing the necessary data entry. As we prepare for the new world of PDGM, the Intake Department will be an integral part of the team.

The Home Health industry continues to evolve: the updated Conditions of Participation (CoPs) in 2018, then OASIS-D and the Review Choice Demonstration (RCD) in 2019, and now the Patient-Driven Groupings Model scheduled for 2020, just to name a few!  Change can be exhausting, so it is comforting to know that some things aren’t changing...like documentation!