The PDG, or Home Health PPS Grouper Software (Hogs), relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDG, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.
Archived versions of the Home Health Prospective Payment System (HH PPS) Grouper are available for download. The HH PPS Grouper software will only work for OASIS submissions with an assessment completion date from through December 31, 2019.
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CMS finalizes higher Home Health Rates for 2019, lays groundwork for greater use of remote patient monitoring The final rule increases payments, and allows for greater use of non-telehealth home patient monitoring. The proposed change would take effect for home health periods of care beginning on or after January 1, 2020.
Congress mandated the reduced episode timeframe in the BBA, but required CMS to implement the change in a budget-neutral manner. Under the final rule, therapy thresholds for home health payments are replaced by the Patient-Driven Group Model (PDG).
Taking patient information and the practices of home health practitioners into account, the PDG will make adjustments based on a series of detailed payment categories such as diagnosis, functional level, comorbid conditions, and admissions source. As part of the PDG model’s move towards more detailed information on services provided, CMS finalized a shift away from estimating costs during a home health episode via the Wage-Weighted Minutes of Care (WWC), which uses industry-wide Bureau of Labor Statistics (BLS) data on home health providers.
In its place, CMS will use a Cost-Per-Minute plus Non-Routine Supplies (CPM + NRS) methodology derived from the Medicare Cost Report. As part of the implementation of the new case mix system, CMS is making available agency-level impact projections and an interactiveGrouperTool that will allow Has to determine case-mix weights for their patient populations.
CMS defines remote patient monitoring in regulation for the Medicare home health benefit as “the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the HHA.” Although the cost of remote patient monitoring is not separately billable under the HH PPS and could not be used as a substitute for in-person home health services, the final rule allows home health agencies to use remote patient monitoring to support the care planning process.
As the HHV BP prepares for its fourth year of operation, the final rule refines the measures for the model’s quality and outcomes scoring system. The rule finalized the removal or modification of several Outcome and Assessment Information System (OASIS)-based outcome measures and replaces them with two composite measures designed to capture the total change in a home health patient’s capacity for self-care and mobility.
The Centers for Medicare & Medicaid Services (CMS) is launching new payment models for skilled nursing facilities and home health care. This model replaces the Resource Utilization Group, Version IV (RUG-IV), which we will no longer support.
“We often see an increase in the volume of Medicare audit activity when documentation requirements or payment models change,” Matthew Wolfe, partner at the North-Carolina based health care legal firm Parker Poe, told Home Health Care News. In short, if providers misunderstand PDG’s requirements or fail to change their operations appropriately, not only could it affect their reimbursements, but it could also prompt an audit into their agency.
Take, for example, a provider who significantly cuts back on therapy as a result of PDG, which eliminates therapy-visit volume as a guaranteed revenue-driver for home health agencies. “If they do that, it’s going to indicate one of two things to the Centers for Medicare & Medicaid (CMS),” Michael Kari, co-founder of Optima Healthcare Solutions, told Then.
To protect themselves against audits in a post-PDGM world, agencies should have data and documentation to back up their processes, as well as justify any operational changes they make for the new model. “One of the opportunities we see agencies have right now in preparation for PDG is to reassess their clinical data documentation,” Britain Novella, senior product owner at Optima, told Then.
Additionally, to ensure agencies don’t overcorrect for PDG, they should educate themselves about how their reimbursements will change under the new model. Under the new model, a patient discharged to home health from the hospital yields $600 to $800 more for an agency than a community referral, according to Optima.
Meanwhile, Wolfe warns providers that under PDG they’ll need to beef up their compliance processes, checking up on and training employees regularly. In the event a CMS contractor finds an agency has been overpaid or acted fraudulently, the provider will likely want to enter into the Medicare appeals process, which has five steps.
Recently, a number of federal court judges have granted providers preliminary injunctive relief during the third level of the appeals process, ultimately delaying an agency’s required repayment and allowing them to continue operating. Virtual Conference Get ahead of the CPT Evaluation and Management changes taking effect in 2021.
Learn more Use this calculator to find a Hips code and estimated payment based on the Home Health PDG (Patient-Driven Grouping Model). A handy calculator to guide you step-by-step through gathering the data necessary to determine a Hips code and estimated payment based on the Home Health PDG (Patient-Driven Grouping Model).
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Community: No acute or post-acute care in the 14 days prior to the HH admission A post-acute stay in the 14 days prior to a late home health 30-day period would not be classified as an institutional admission unless the patient had been discharged from home health prior to the post-acute stay.
Details: Home Health Solutions sells a PDG Decision Tree in its online store to help agencies with the decision-making process. Our tool captures the decision-making process in a simple, easy-to-follow format which you can easily share with your staff members.
Performing an audit of your coding practices now will provide the opportunity to educate your staff on accurate and cohesive coding guidelines and targeted aspects of the OASIS to ensure you are prioritizing both patient needs and accurate reimbursement. Details: This article provides information on the implementation of the new Home Health Prospective Payment System (HH PPS) case-mix adjustment methodology named the Patient-Driven Groupings Model (PDG).
Details: PDG ICD Lookup In the new PDG (Patient Driven Groupings Model) payment model effective 2020, the Primary DX will be very important in order to determine what payment group your claim will fall under. Details: PDG: an overview for all home health leaders and staff Get a comprehensive overview of the Patient Driven Groupings Model (PDG) from Gina Mazda, BSN, RN, CHQ, Senior Vice President of Regulations and Compliance at Jazz Associates.
Details: PDG is a major change in the home health industry and is expected to be a resource hog when it goes into effect in January. Instead of stretching your staff thin manually updating eligibility data, consider a service that automates the process.
Details: Home Health providers need to be proactive in identifying the impact as well as planning how to change operations to fit the new PDG model. Check out these resources to see how our automated software is the perfect tool to tackle PDG’s shorter billing cycles, new Luna thresholds and complex coding requirements.
Details: DecisionHealth provides news, guidance, education and tools to maximize the revenue cycle and financial health of healthcare organizations. ... We put this knowledge to build state-of-the-art PDG features into our home health software and answer more than 100 frequently asked questions.
Details: SHP is pleased to announce the release of our completely redesigned Her Worksheet tool. SHP has taken this opportunity to re-engineer the report to accommodate the new payment rules and highlight potential revenue ...
Details: Transitioning to the Patient-Driven Groupings Model (PDG) has already begun to impact operations for home health agencies. Diagnosis coding and OASIS ADL data are two significant areas that the agency can impact by gaining a deeper understanding of both items.
Details: PDG Impact on Your Agency: A Simplified Tool Posted on November 1, 2018, July 30, 2019, by Jazz Associates Last month we encouraged you to access the information that CMS has provided to learn the potential impact of the Patient-Driven Groupings Model (PDG) on your agency. This tool was created and shared by Lori Apple, RN, president & CEO of Corsica in Milford, Mich.
We provide outstanding accuracy, best practices and extensive quality assurance protocols to ensure the reliability you’ll need. We offer a variety of health compliance training and online courses for healthcare providers.
Details: During this session, we will explore in depth the issues that can arise with ICD-10-CM coding under PDG, primarily through case study analyses. We will present detailed analyses of these issues and discuss action plans and best practices home health agencies can implement in order to effectively manage challenging coding scenarios in PDG.
Details: The process of coding and OASIS (Outcome and Assessment Information Set) review plays a critical role in profitability of home health organizations. Accuracy and timely completion can help agencies achieve the right balance, and support maximum reimbursement, under Patient-Driven Groupings Model (PDG).
As your home health partner, McGee, an industry leading, premier health care professional services firm is committed to helping you prepare for the coming changes related to the Patient-Driven Groupings Model (PDG). This new methodology is complex and brings significant change for home health agencies impacting nearly all aspects of operations.
Details: It’s pretty safe to say that 2020 was a roller coaster of a year for contract therapists in the home health space. From staying on top of COVID-19 to navigating the transition to the Patient-Driven Groupings Model (PDG), we’ve had our hands full since we put away the party hats and champagne flutes on January 1st. As we enter the latter part of the year, some transitional dust ...
Details: Key industry resources and linksCOVID-19 Information & Resources List of States Where NPS Can Sign Orders Patient Guide for COVID-19 Home Health Face-to-Face Checklist Pandemic Infectious Disease Policy General Telemedicine Toolkit COVID-19 Home care & Hospice Checklist Official Coding Guidelines for COVD-19 Coder Tools Medication Compliance Aids for Home Health Managing Your Medicines ... Details: Identify critical challenges and pinpoint where future opportunities exist under PDG.
McGee can help you make a successful transition with solutions for redesigning processes, staff education and KPIs to monitor ongoing performance. Details: As home health agencies continue to plan for the implementation of PDG there are some very important questions that agencies need to ask their software and electronic medical records (EMR) vendors in order to be prepared for the changes in clinical documentation and billing of Medicare Home Health claims.
Details: President, North Country Home Health & Hospice, Littleton, New Hampshire Simone Healthcare Consultants was instrumental in helping our agency evaluate its three business lines with a combined census of 400+, assessing operations, finance, sales and marketing efforts. Details: Certified Hospice Coding Specialist (HCS-H) Mission Statement Home Health Solutions, LLC is dedicated to improving the post-acute industry through our accuracy, integrity, and efficiency; allowing agencies to be patient-focused, compliant, and maximize reimbursement for patient care.
Details: Use Technology to Effectively Navigate PDG, Improve Coding Productivity, and Ensure Accuracy! Empower your home health agency with the only tool your coding & OASIS staff need to submit clean claims for fast and full reimbursement.