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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.

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:

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).

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:

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.

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.

Earlier this year in quarter one, the National Association of Home Care and Hospice (NAHC) released preliminary data specific to the early PDGM claims and trends*. This was our first opportunity to be able to begin benchmarking performance compared to the trends that were occurring across the home health industry. HealthPRO Heritage at Home then performed a deeper investigation into each specific PDGM clinical grouping and determined...

On June 26, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Home Health proposed rule for 2021.

There were little to no changes with the PDGM payment model and it’s clear that PDGM is here to stay.  Additional highlights from this proposed rule are listed below:

As the number of new COVID-19 cases rise and fall across the country, HealthPRO Heritage at Home reminds you that we are prepared above & beyond. Our 3-prong approach + Partnership Pledge provides support in the case of a second wave, or if infections increase in your market.

For 15+ years, HealthPRO Heritage at Home has served the therapy needs of home health agencies who have counted on us as a trusted partner to address the challenges and opportunities unique to home health.

As the industry navigates changes brought by PDGM and COVID-19, HealthPRO Heritage at Home is well prepared to support partners with meaningful guidance and sophisticated resources that fortify operational success, financial growth, and clinical excellence, including: