Welcome to the HealthPRO Heritage Blog

HealthPRO Heritage has summarized important updates from a memo released by the Department of Health & Human Services found here and a memo released by CMS found here.

Amidst the COVID-19 crisis, HealthPRO Heritage shares an important resource. 

This is information is updated as of 03/12/20

This is information is updated as of 03/12/20 at 1:00pm EST

In the unfortunate event that a resident or patient in your care is a confirmed COVID-19 case, please note special ICD-10 coding will be necessary. The CDC released official diagnosis coding guidance for encounters and deaths related to the 2019 novel coronavirus (COVID-19), effective February 20, 2020.

The Patient Driven Grouping Model (PDGM) was implemented January 1, 2020 and changed reimbursement models of Medicare home health services from therapy utilization driven to patient characteristics. While this has allowed for a focus from quantity to quality, some home health agencies are restricting therapy visits and placing their quality measures, Star Rating, and most importantly patient outcomes at risk. CMS calculates Star Ratings through several areas therapy may influence including, ambulation, bed transfers, bathing, discharge location, and rehospitalizations.

When it comes to clinical reimbursement opportunities, HealthPRO Heritage asks: “Is your clinical team leaving no stone unturned?” As national healthcare consultants with a progressive approach to PDPM, HealthPRO Heritage offers five simple (but not easy*) strategies to compliantly optimize clinical-based reimbursement.

"If it were easy….then everyone would do it!"

CMS issues warning to home health agencies – don’t aggressively change your therapy utilization! 

“There is no need to drastically change behavior,” says Senior Vice President of Home Health Operations David Jones. “In fact, agencies that do are at risk under the watchful eye of CMS.”

In the past years, overutilization of therapy had been a concern for CMS as most agencies were using therapy as a driving force for reimbursement under the previous prospective payment system and had identified significant overutilization of therapy visits by as much as 30-40%. However, audits revealed that nursing visits were also over utilized along with therapy. One would assume that nursing should be equally held accountable under PDGM for patient improvements as well and not assume that they get a free pass. However, there has been no reduction in the nursing salaries, workforce, or in their allowed patients visits thus far under PDGM by most agencies. Nursing visits were never a factor contributing to reimbursement, yet are still valued as an integral contribution to a home health episode. Therapy should not be different. PDGM does eliminate therapy-visit volumes as a determining factor in calculating reimbursements, but that does not mean that the need for therapy has changed. Therapists are strategically positioned to promote, enhance, and improve a patient’s functional abilities in the realm of home health; however, there are barriers to their services because of some agency practices. This may include reduction in therapy visit utilization, frequency or restricting disciplines.

To achieve, or maintain high marks on performance outcomes – and ultimately drive census & fiscal upside – HealthPRO Heritage suggests: Supercharge your strategy with on-the-ground support for your Nursing team. 

With one month since the PDGM transition, the industry asks, “How can we assure and measure whether our teams are successfully navigating the transition to PDGM?” Jason Sasser, PTA/CWT/CSST/ COQS, Vice President of Clinical Strategies, HealthPRO Heritage at Home, reflects on the industry’s most pertinent questions related to PDGM best practices and how to measure success.