Welcome to the HealthPRO® Heritage Blog

Understanding F2F, TPE, and RCD

Posted on: October 8, 2019

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.

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Tags: Home Health, TPE, PDGM, Patient-Driven Grouping Model, RCD, F2F

LUPA Management: Avoiding the 4 Letter Word

Posted on: September 27, 2019

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. 

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

Achieving Agency Growth Under PDGM

Posted on: September 11, 2019

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.

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Tags: Home Health, PDGM, Patient-Driven Grouping Model

Will You Sink or Swim in PDGM? Care Pathways to Success

Posted on: August 28, 2019

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

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Tags: CMS, Home Health, PDGM, Patient-Driven Grouping Model

Intake Isn't Just Intake Anymore: Important Steps in PDGM Referral Processing

Posted on: August 13, 2019

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.

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Tags: Home Health, PDGM, Patient-Driven Grouping Model

The Only Constant is Change...and Documentation

Posted on: August 7, 2019

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!

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Tags: Home Health, PDGM, CMS Update 2019

Home Health Agency Cash Flow: How Low Will It Go?

Posted on: July 30, 2019

Following the recent NAHC Financial Management Conference in Chicago, HealthPRO® Heritage representatives in attendance outlined principal key concerns affecting home health agencies going forward into PDGM implementation. 

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Tags: PDGM

CMS Issues Updated Home Health Proposed Rule - Taking the Good with the Bad

Posted on: July 12, 2019

On July 11, 2019, Centers for Medicare & Medicaid Services (CMS) issued the 2020 Home Health Prospective Payment System (PPS) Proposed Rule (effective January 1, 2020). While many of the provisions in the original Patient-Driven Groupings Model (PDGM) remain unchanged, the home health experts from HealthPRO® Heritage at Home offer the following summary of important updates:

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Tags: PDGM, Patient-Driven Grouping Model

PDGM and Questionable Encounters

Posted on: July 9, 2019

As PDGM edges closer, there is rising concern and tension around the submission of claims that contain primary diagnoses that do not fall into one of the 12 clinical groupings established by CMS. Such primary diagnoses are known as "Questionable Encounters" (QEs). QE codes are "too vague," meaning the code did not provide adequate information to support the need for home health services. CMS listed 43,287 eligible primary diagnoses codes in their PDGM Grouper Tool. 

Under PDGM, claims for QEs will be sent back to the agency as "Return to Provider" (RTP) since CMS will not be able to assign the 30-day period to one of the 12 PDGM clinical groups. 

Examples of the Top 25 QE Codes:

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Tags: PDGM, CMS Update 2019

PDGM Preparedness To-Do List

Posted on: July 2, 2019

Start preparing TODAY to guarantee your agency's success in the future. 

HealthPRO® Heritage at Home's team has compiled the following checklist that can help organize a plan of action for agencies affected by the future of PDGM.

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Tags: PDGM