Welcome to the HealthPRO Heritage Blog

Understanding the Financial Penalties with Late RAP Submission in 2021

Posted on: November 24, 2020

As most home health providers are aware, beginning on 1/1/21 financial penalties will start to incur for any RAP (Request for Anticipated Payment) submission that occurs after 5 days from when a patient is admitted to home health services. Here is a breakdown of what this updated RAP submission will look like and exactly what financial penalties will occur:

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Tags: PDGM, Home Health Agency

Ensuring Financial Solvency with LUPA Mitigation and OASIS Scoring

Posted on: November 17, 2020

Reimbursement, revenue, payment, or better yet, the term “cash flow” seems to be on the mind of every home health agency in the nation today. Not only were agencies hit with the RAP reduction from 60% to a minimum 20% with the start of PDGM in January 2020; but the COVID-19 pandemic, which began in March, seemed to throw gasoline onto an already large cash flow fire by increasing the occurrence of LUPAs (Low Utilization Payment Adjustment).

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Tags: PDGM, Home Health Agency, LUPA

In a Year of Tricks, CMS Drops a TREAT with Home Health Final Rule

Posted on: October 30, 2020

CMS released the 2021 home health final rule on Thursday, October 29, 2020. HealthPRO Heritage at Home sorted through the mixed bag and found more treats than tricks!

There were minimal changes compared to the home health proposed rule that was released in July 2020. Probably the best news in the rule was the 1.9% aggregate increase (or $390 million) in reimbursement that agencies will realize in 2021. Although the increase was less than the original 2.6% increase that was in the proposed rule.

Other highlights from the final rule are as follows:

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Tags: PDGM, Home Health Agency, COVID-19

In a Year of Tricks, CMS Drops a TREAT with Home Health Final Rule

Posted on: September 24, 2020

CMS released the 2021 home health final rule on Thursday, October 29, 2020. HealthPRO Heritage at Home sorted through the mixed bag and found more treats than tricks!

There were minimal changes compared to the home health proposed rule that was released in July 2020. Probably the best news in the rule was the 1.9% aggregate increase (or $390 million) in reimbursement that agencies will realize in 2021. Although the increase was less than the original 2.6% increase that was in the proposed rule.

Other highlights from the final rule are as follows:

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Tags: Home Health, PDGM, Home Health Agency

Home Health + COVID-19: Clinical and Financial Benefits

Posted on: September 15, 2020

While the medical industry learns to operate during COVID-19, HealthPRO Heritage at Home believes there has never been greater demand for home-based care options or recognition of the power and benefits of care delivered in the home, whether in person or through telemedicine.

The nationwide outbreak of COVID-19 has had a major impact on our healthcare system, and home health agencies across the country have been working hard to continue providing quality health care and services to their patients. Alongside the cost pressure of the 2020 Patient-Driven Groupings Model (PDGM) pressures, Medicare (CMS) continues to grow, with around 10,000 new individuals added to their roster every day.

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Tags: PDGM, Home Health Agency, COVID-19

Solutions for HHAs Amidst COVID-19 + PDGM

Posted on: April 9, 2020

HealthPRO Heritage at Home: PPE/Safety Update
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Tags: PDGM, Home Health Agency, COVID-19, Coronavirus

A True Home Health Partner through the COVID-19 Crisis

Posted on: March 18, 2020

Amidst the COVID-19 crisis, HealthPRO Heritage has organized a multi-faceted approach to preparedness and promotion of safe treatments to our patients, and implementation of strict precautions to prevent the risk of the virus spreading. Our Physical, Occupational, and Speech Therapists remain available and ready to serve the immediate patient care needs of our agency partners, many of whom are reporting staffing challenges.

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Tags: Home Health Agency, COVID-19

The Dangers of Therapy Underutilization Part 2: The Effect of Patient Outcomes on Star Ratings

Posted on: March 6, 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.

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Tags: Home Health, Senior Living Community, PDGM, Patient-Driven Grouping Model, Home Health Agency

The Dangers of Therapy Underutilization - Part 1: The CMS Perspective

Posted on: February 18, 2020

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.

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Tags: Home Health, PDGM, Home Health Agency

RCD: Are You Ready?

Posted on: January 23, 2020

Review Choice Demonstration came to Ohio September 30th, 2019 and hot on its heels is PDGM. The more prepared you are for all of the changes that come, the better poised your agency will be in the coming months and years.

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Tags: Home Health, PDGM, Home Health Agency