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
==========================================================================
