Preparing for the CMS Home Health PPS final rule for 2020, commonly known as PDGM, is going to take some effort. Stories have already reached us about interpretations that do not quite get the story right. Fortunately, many state and national associations, EMR vendors, and consulting organizations are scheduling multiple educational opportunities, both for this year’s changes and next year’s anticipated arrival of the new PDGM billing system.
We will do everything we can to keep our list of seminars and webinars up to date. We attended an early one just last week, the 8th Annual “Compliance Cruise,” organized by the home health law firm of Bernard and Pearson. The principals took us step by step through PPS, PDGM, and labor laws, then turned the stage over to experts in cost reports, clinical documentation, sales and technology.*
Here is a briefing on the major points brought out during this three-day seminar on compliance. (more…)
The Hospice Quality Reporting Program (HQRP) currently consists of two reporting requirements: the Hospice Item Set (HIS) and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. HIS and Hospice CAHPS® data are used to calculate performance on quality measures. (more…)
By Tim Rowan, Editor and Publisher of Home Care Technology Report.
Preparing for the CMS Home Health PPS final rule for 2020, commonly known as PDGM [Patient-Driven Grouping Model], is going to take some effort and interpretation of what CMS is demanding of HHAs is not straightforward. As Rowan, fortunately”many state and national associations, EMR vendors, and consulting organizations are scheduling multiple educational opportunities, both for this year’s changes and next year’s anticipated arrival of the new PDGM billing system.” In addition, Rowan notes;
”Elsewhere in this issue [of HCTR], we also offer a guest article by a physical therapist who offers an objective analysis and recommends early preparation activities.” Rowan adds; ”We will do everything we can to keep our list of seminars and webinars up to date. We attended an early one just last week, the 8th Annual “Compliance Cruise,” organized by the home health law firm of Bernard and Pearson. The principals took us step by step through PPS, PDGM, and labor laws, then turned the stage over to experts in cost reports, clinical documentation, sales and technology.”
Rowan specifies the following point about the Compliance Cruise presentations;”Here is a briefing on the major points brought out during this three-day seminar on compliance.
There will be five payment categories, plus one “catch-all” category. Patients will be assigned based on primary diagnosis.
Musculoskeletal Rehabilitation
Neuro/Stroke Rehabilitation
Wounds – Post-Op Wound Aftercare and Skin/ Non-Surgical Wound Care
Complex Nursing Interventions
Behavioral Care
Medication Management, Teaching and Assessment (MMTA)
Because category 6 is so broad, and will include most patients, CMS agreed to break it into six sub-groups:
Surgical/Procedural aftercare
Cardiac/Circulatory
Endocrine
Infectious/Blood Forming Diseases/Neoplasms
Respiratory
Other
Cost report consultant Jim Plonsey reported that he has heard some state association seminars are declaring “Medicare will no longer pay for therapy.” The rule, according to Plonsey, actually adds an average therapy amount to every episode payment.
LUPAs will be anywhere from two to seven visits, depending on diagnosis and assigned payment group. Someone will have to be assigned to know the LUPA threshold for each patient.
An admission that occurs within 14 days of a hospital discharge is categorized as an “institutional discharge,” and is paid at a higher rate. After 14 days, or without any hospital stay, it is a “community admission” and not only paid less but also triggers the Face-to-Face document requirement.[We advise readers to consult this article for details on more specifics about payment changes under the new PDGM model for healthcare at home. The author also provides a full, objective comparison of per-person costs for the recent Compliance Cruise.]
Compliance Cruise 2018 Costs
$50-$100
$595
$1,300
Homecare 100
$1,050
$0
$3,500
$4,550
NAHC Annual
$1,200
$100-$200
$695
$2,100
Elevating Home
$638
$100-$200
$899
$1,738
Compliance Cruise
$750 – 1,200
$0
$900
$2,000
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
TAGS
Patient-Driven Grouping Model –PDGM–and payment guidelines to healthcare at home agencies, PDGM–and billing guidelines under it, PDGM–and categories of patients under it, Compliance Cruise 2018–participants’ costs
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by James Cohen
Why Integration Within Home Care Is No Longer a Choice
As we all know, connectivity is an incredible feature of our time—linking us to the world and to one another as never before. But how does it happen? How do different devices, applications and systems communicate with each other when we book flights or do our banking online? More importantly, how does it affect healthcare? (more…)
by Tim Rowan, Editor
In the briefest of news releases, Chicago-based Allscripts notified investors that it has sold its remaining share in Netsmart.
On December 31, 2018, after a nearly six-month search for an investor, Allscripts (NASDAQ: MDRX) closed the previously announced sale of its interests in Netsmart Technologies, Inc. (more…)
by Tim Rowan, Editor
Changing payment systems, aging population, a shrinking Medicare Trust Fund, the growing use of Medicare Advantage, massive uncertainty in all three branches of the Federal government, all impact how healthcare providers plan for the future. Such an impact falls just as heavily on the technology vendors that serve them. (more…)
The innovative healthcare companies have partnered to offer care management solutions that enable hospitals to improve the post-acute patient experience.
OMAHA, Neb. – December 6, 2018 – Ensocare, a leading provider of technology-enabled care management solutions, has announced a new partnership with Wellpepper, an award-winning and clinically-validated patient engagement platform used by major health systems to improve outcomes and lower costs of care. (more…)
by Tim Rowan, Editor
You do not need to hear the demographics speech again. You know all about the 76 million Baby Boomers who are turning 65 at the rate of just over 10,000 per day. Suddenly, however, that familiar trope takes on new meaning.
Thanks to research published in NIH’s National Center for Biotechnology Information, Baby Boomer aging demographics can be seen in the specific context of their impact on post acute care (PAC). The study declares that post-acute care is one of the fastest growing areas of U.S. healthcare, with a reported 40 percent of older Americans discharged from a hospital utilizing home health, skilled nursing facility, inpatient and outpatient rehabilitation, but that is not what will make this a landmark study. (more…)
By Eliabeth S. Hogue, LLB
The U.S. District Court for the Southern District of Texas ruled in Adams EMS, Inc. v. Azar, No. H-18-1443(S.D. Tex. July 11, 2018) that the Centers for Medicare and Medicaid Services (CMS) could not recoup monies until after Administrative Law Judge (ALJ) hearings have been held. The Court issued a temporary restraining order (TRO) prohibiting CMS from recouping an overpayment.[The ALJ’s hearings had been held. In this case, the Court issued a TRO prohibiting cases from recouperating any overpayment. Hogue provided more details about the ZONE PROGRAM and receiving overpayment on claims submitted between July 17, 2010 and Jan. 15, 2016.
Further details are provided on the recoupments and requirements of parties involved with this case and CMS’s involvement in the case and other activities and, as the author concludes the piece about the court’s ruling on recouping of home health agency monies, the focus must be to appeal AJL precedents set in 2010 and 2016.
by Tim Rowan, Editor
Kindred Healthcare, LLC and Netsmart announced on December 18 a partnership to create what the companies describe as a unique, technology-driven clinical platform that surpasses the traditional boundaries of electronic medical records and aligns with the needs of the evolving value-based care environment. Through this partnership, the companies expect to build and support integrated post-acute solutions, improve care outcomes and address gaps in patient care.
We spoke with Netsmart VP Kevin Scalia to get his take on the partnership. (more…)
