Welcome to the HealthPRO® Heritage Blog

Ticket to Ride: OASIS Will Drive Success Under PDGM

Posted on: April 30, 2019

Accurate OASIS coding has always been important, but with PDGM on the horizon, our ability to master the OASIS will be imperative! After all, accurate OASIS coding will directly impact an agency’s ability to achieve optimal outcomes and support reimbursement in today’s and tomorrow’s world.

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

Get Ready for PDGM

Posted on: April 25, 2019

Implementation of the new case-mix classification model, the Patient Driven Grouping Model (PDGM), on January 1, 2020 will bring BIG changes to the home health profession! HealthPRO® Heritage at Home is ready to help you start preparing TODAY for the most dramatic Medicare reimbursement change since PPS.

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

Under PDGM: Revenue Cycle Matters

Posted on: April 15, 2019

PDGM implementation is a mere 38 weeks away, bringing significant changes in episode length (60 to 30 days), resultant billing processes, revenue cycle, and ultimately, cash flow. While certification periods will continue to be 60 days in duration, reimbursement will be broken into 30-day payment periods. As such, billing will have to be processed for each 30-day payment period including Requests for Anticipated Payment (RAPs) and final claims. This will likely result in a substantial increase in claims volume in addition to an interruption in cash flow. Specifically, agencies will experience a cash flow “crunch” during the first few months of implementation as the conversion from 60-day to 30-day payments is realized with a leveling off after the initial impact and conversion.

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Tags: Home Health, PDGM, Revenue, Patient-Driven Grouping Model, PrepareExecuteSucceed, Episode Length of Stay, ELOS

Home Health Providers: Leverage QAPI Plan to Prep for PDGM?

Posted on: October 1, 2018

In the recently updated Conditions of Participation, CMS spells out what they expect from a QAPI program. Additionally, the final draft of the interpretive guidelines (IG) for the Home Health Agency Conditions of Participation (CoP) was released last month.

How can agencies use this already mandatory requirement to help prepare them for the expected changes coming in 2020 with the proposed Patient Driven Groupings Model (PDGM)?

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Tags: Home Health, QAPI Plan, PDGM

From PDPM to PDGM: Home Health in the Hot Seat

Posted on: August 30, 2018

How Will the Recent Home Health Proposed Rule Affect the PAC Industry?

NOW WHAT?
PDGM (Patient-Driven Groupings Model) was recently announced in July as part of the Proposed Rule published by CMS and is anticipated to be THE biggest change in home health reimbursement 20+ years!

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Tags: Home Health, CMS Update 2018, PDGM

Are You a Home Health Provider Struggling with Physician Communication?

Posted on: June 8, 2018

If you’re struggling with physician communication, you’re not alone. We know that communication leads to better care coordination. That is a no brainer. Yet, we continue to see communication challenges in home health (and other areas) because of regulations, documentation requirements, and a million other things. If we had well-coordinated care and best practice communication strategies, there would be less discrepancies in medication lists and more time and complete access to hospital records among other things. This would allow our clinicians the ability to hit the ground running with individualized care from the start.

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Tags: Home Health, Care Continuum

January Advisor Newsletter

Posted on: January 26, 2018


Attention: CMS has released updated quality measure star ratings for all LTC providers. The Nursing Home Compare site was updated January 24, 2018.



RCS-1: Get Ready, While We Watch & Wait

HealthPRO®/Heritage continues to lead the industry in preparation for RCS-1 as we prepare for a likely reimbursement system overhaul.

Based on the fact that CMS received a high volume of comments from industry stakeholders during the extended public comment period through August 2017, we expect there will be some changes to the Advance Notice Proposed Rulemaking (ANPRM) regarding the complete overhaul of PPS. We do know that payment reform is coming, and we must be prepared for a big change in our industry. We will stay close to the proposed changes to be released in April 2018. 

HealthPRO®/Heritage strategy is to watch, to wait and to BE PREPARED! The providers who come out on top will be the ones most well prepared to weather the transition, should the system change occur as scheduled on October 1, 2018.

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Tags: CMS, HealthPRO/Heritage, senior living, Home Health, RCS-1, Nursing Home Compare Website, Bundled Payments, BCPI, Bundled Payment for Care Improvement Advanced

November Advisor Newsletter

Posted on: November 10, 2017

IMPORTANT REMINDER: November 16 is the deadline for submitting staffing data for the period of July 1 to September 30. Providers that miss this deadline are subject to suppression of your “Overall Staffing Rating” and “Registered Nurse Staffing Rating” for the December 2017 Nursing Home Compare update.

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Tags: skilled nursing facility, CMS, Long Term Care, Advisor Newsletter, Advisor, Home Health, QAPI Plan

Advisor Newsletter - September 2017

Posted on: September 26, 2017

RCS-1 Reimbursement Crosswalk ModelLooking for Guidance on Jimmo v. Sebeilus?Countdown to Major Home Health Changes



RCS-1 Reimbursement Crosswalk Model
HealthPRO®/Heritage has developed a proprietary, sophisticated RCS-1 Reimbursement Crosswalk Model that will help us work strategically with partners to assess aggregate reimbursement risk and understand the interplay between nursing and therapy reimbursement components. The model is dynamic, allowing behavior changes to be modeled so providers can see the impact of specific elements that significantly drive reimbursement under RCS-1 (e.g.: such as diagnostic coding, cognitive assessment, and ADL scoring).

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Tags: Jimmo V Sebelius, PAC provider, HealthPRO/Heritage, Advisor Newsletter, Advisor, Home Health, RCS-1, Jimmo v. Sebeilus, CMS policy, Crosswalk Model, CMS Calculator, Skilled Therapy

July 2017 Advisor Newsletter

Posted on: July 28, 2017



IN THIS ISSUE:
Introduction to RCS-1 • SNFs & HHAs Scorecards: Let’s Get on the Same Page 
SNFs & HHAs: What About the PEPPER?
 • Letters of Non-Compliance with SNF QRP: Threatening Up to 2% FY 2018 Annual Payment Update (APU)


NOTICE: CMS announced on June 25th that Quality Reporting Program (QRP) data for Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) is due August 15, 2017 for the first quarter of 2017.

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Tags: skilled nursing facility, snf, HealthPRO/Heritage, Advisor Newsletter, SNF Operators, Advisor, Home Health, RCS-1, QRP non-compliance letters