Welcome to the HealthPRO® Heritage Blog

CMS' Final Rule is Here!

Posted on: July 31, 2019

Tuesday was the day! On July 30, CMS released the FY 2020 Final Rule for Medicare payment rates and quality programs. This is the moment we have all been waiting for. PDPM is 9 short weeks away, and the industry finally has clarifications RE: the new payment model.

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Tags: The Final Rule, Patient-Driven Payment Model, PDPM, 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

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