As most in the industry are aware, current Medicare policy does not allow occupational therapy alone to establish eligibility for home health services, unlike physical therapy and speech-language pathology. Occupational therapy plays an essential role in home health, but is currently only able to stand alone or continue services after an individual has been discharged from all other home health service.Read More
Welcome to the HealthPRO Heritage Blog
Posted on: January 8, 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:Read More
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).Read More
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:Read More
Posted on: September 24, 2020
CMS began enforcement of Review Choice Demonstrations (RCD) on August 3, 2020. Home health providers in North Carolina and Florida were able to select their initial choice between August 3, 2020 and August 17, 2020. Home health in all demonstration states (Illinois, Ohio, Texas, North Carolina, and Florida) with billing periods beginning on or after August 31, 2020 will be subject to review under the choice selected.Read More
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.Read More
Posted on: April 9, 2020
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.Read More
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.Read More
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.Read More