Since the implementation of the Patient-Driven Groupings Model (PDGM) in 2020, there have been new complexities in home health coding that have made it challenging for agencies to optimize reimbursements. Data from 2020 revealed that home health organizations did not meet CMS reimbursement projections in the first year of PDGM. Total home health case…
Transition to Value-Based Care The healthcare industry, particularly home health, is a landscape that is constantly changing with frequent updates on regulatory requirements and new standards. In an effort to improve payment systems, the Centers for Medicare and Medicaid Services (CMS) has recently been promoting value-based care in home health in which the Home…
Last June 28, the Centers for Medicare & Medicaid Services (CMS) issued the Home Health Prospective Payment System (HH PPS) proposed rule for 2022, which re-focuses the shift from paying for home health services based on volume to a system that incentivizes higher quality care. One of the most significant and noteworthy changes is…
When OASIS submission, coding, and QA review were streamlined, Qavalo’s client agencies saw significant improvements in their OASIS turnaround time and realized better compliance and profitability. With the right outsourcing partner, Qavalo clients have been able to get the support their in-house teams need to find efficiencies in their documentation workflow and seize big…
Recent discussions about the expansion of the Home Health Value-Based Purchasing Model (HHVBP) signal major reforms on the horizon for home health operations and payment systems. Allow us to dive into what this means for the different industry stakeholders: What Is Value-Based Care? According to the Centers for Medicare and Medicaid Services (CMS), value-based…
LUPA and the Pandemic In the first few months of the Patient-Driven Groupings Model (PDGM), the frequency of low-utilization payment adjustments (LUPAs) increased for many home health providers to 9.5% according to a home health news source. While this aligns with the projection from the Centers for Medicare & Medicaid Services (CMS) that about 10%…
Effective January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) will replace the No-Pay Request for Anticipated Payment (RAP) with a home health Notice of Admission (NOA). The No-Pay RAP was implemented in 2021 as part of the home health regulatory changes of Section 1895(b)(2) of the Social Security Act (the Act),…
Staffing Is Home Health’s Biggest Challenge The 2021 Outlook Survey by Home Health Care News (HHCN) revealed that 59% of the respondents said that staffing remains their single-most challenging aspect of home health operations. With the onset of COVID-19, healthcare demand has increased drastically, overwhelming the supply of clinicians. Home health providers have struggled with…
The Challenge The Centers for Medicare & Medicaid Services (CMS) addressed concerns regarding GG codes in the recently released Outcome Assessment Information Set (OASIS) Q&As for quarter 1 of 2021. Clinicians still find it challenging to correctly assess and code the functional M items and the GG items since the revision of OASIS from version…
The New CMS ADT Mandate There is a new mandate from the Centers for Medicare and Medicaid Services (CMS) on sharing admissions, discharge, and transfer (ADT) data among care providers, with the aim of improving care coordination and lowering readmissions. As of May 1, the new regulation will require hospitals to notify all applicable…