Welcome to the HealthPRO® Heritage Blog

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

The Bright Future of Rehab Includes Student Clinical Affiliations!

Posted on: July 11, 2019

Among the many important decisions related to the PDPM transition is the question of whether SNFs and their rehab partners should accept students for clinical affiliations.  As strategy consultants and leaders in therapy, HealthPRO® Heritage offers this guidance: 

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Tags: PDPM, CMS Update 2019

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

(Re)Consider the Optimal Therapy Model for PDPM & Beyond!

Posted on: July 1, 2019

Decisions. Decisions. Since the industry began wrapping their heads around RCS-1 two+ years ago, SNFs continue to weigh the pros and cons of retaining in-house therapy vs. an outsourced model. Questions arise: What does payment reform mean for SNFs with their own program? Is there a financial or operational advantage to transitioning from full service to in-house or a “managed” in-house model?

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Tags: PDPM, CMS Update 2019, Therapy Model

Focus on Functional Assessments

Posted on: June 26, 2019

It can be easy to get lost in the details of PDGM and forget how vital outcomes and ratings are in driving overall agency success.  It’s one of the biggest reasons why appropriately managing therapy in PDGM is a key competency.

In HealthPRO® Heritage at Home's recent survey with the National Association for Home Care and Hospice regarding therapy in PDGM, 48% of respondents anticipate less therapy utilization. Agencies should be cautioned on cutting therapy utilization given the focus on functional assessment and outcomes.  Functional assessments - completed best by a skilled therapist - will contribute significantly to payment in PDGM, while also continuing to drive publicly reported outcome measures and star ratings.

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

Therapy Thinks Forward: Group Therapy Re-Imagined

Posted on: June 20, 2019

Please don't say "Group Therapy" like it's a 4-letter word!

Because many are thinking of the term "Group Therapy" as though it is a curse word, HealthPRO® Heritage asks you to instead consider re-imagining what is traditionally thought of as Group Therapy. Let’s RE-think and RE-format Group Therapy with an ultra-valuable, super-educational component. In other words, why not re-invent Group Therapy treatments instead as ‘'Group Education Classes'’?

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Industry Feedback on Therapy Under PDGM

Posted on: June 18, 2019

HealthPRO® Heritage at Home partnered with the National Association for Home Care and Hospice (NAHC) to conduct a survey of home health providers to gather industry feedback on therapy utilization under PDGM. HealthPRO® Heritage co-sponsored the survey as part of its ongoing effort to bring strategies and solutions to agencies as they prepare for PDGM. Nearly 700 people took the survey and were made up of representatives in every state from freestanding, institutional, health system and government based agencies from both for and not-for profit settings. 

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Tags: PDGM, CMS Update 2019

HealthPRO Heritage Reports: RAI Manual Updates

Posted on: June 10, 2019

The 2019 RAI Manual is here! The SNF world has been on the edge of their seat in anticipation of how the changes would impact the interdisciplinary team and coding of the MDS assessment.  CMS’ message is clear:  No longer is the manual only for MDS coordinators!  More emphasis on clinical characteristic coding for PDPM case mix group assignment means all disciplines must participate in completion of the MDS. The MDS item sets have been adapted for this shift in the Medicare classification system, requiring significant updates in the go to manual for RAI process.

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Tags: PDPM, CMS Update 2019, RAI

Does In-House Therapy Make Sense Under PDGM?

Posted on: June 5, 2019

The Patient-Driven Groupings Model (PDGM) is a game changer, requiring home health providers to explore new business models based on the introduction of new risks and potentially significant financial impacts.

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