During the COVID-19 pandemic and following the implementation of the Patient-Driven Groupings Model (PDGM), home health agencies faced considerable challenges managing Low-Utilization Payment Adjustments (LUPAs). Although some successfully adopted strategies to reduce LUPAs, many agencies continue to struggle. Current LUPA Landscape According to data from… Read More »How to Address the Ongoing LUPA Challenges
Conducting the Initial Therapy Evaluation There are two objectives to fulfill when conducting the initial therapy evaluation: 1) emphasize that skilled therapy services are medically necessary, and 2) identify the specific areas to focus on during succeeding patient visits. Obtaining approval from the certifying physician… Read More »Enhancing Home Health Therapy Documentation Practices
Face-to-face (F2F) encounters are required to certify a patient’s eligibility for Medicare home health benefits. Face-to-face (F2F) documentation compliance has been a persistent challenge for numerous home health agencies, as it remains a leading cause of Medicare home health claim denials. The guidelines for F2F… Read More »Reviewing the Fundamentals of F2F Compliance
Home health providers are receiving a growing number of patients with more complex medical needs, which requires more specialized care and attention. Overall, patients with higher acuity levels need additional services after leaving the hospital, which makes it more challenging for home health providers to… Read More »Home Health Adapts to Increasingly Complex Patient Cases
The latest version of the Performance and Improvement Progress Report (PIPR) was released in April 2023, accessible through the iQIES system, your usual source for CASPER reports. PIPRs show your current percentile ranking for each outcome measure when compared to agencies nationwide that belong to… Read More »New PIPR is Out: What’s In It for You?
Diagnosis queries have become an increasingly vital process to ensure adequate documentation and accurate coding. However, it is often challenging to obtain timely responses from physicians regarding queries. For instance, the demanding schedules of physicians/providers make it difficult to find an appropriate time for discussions.… Read More »Coding Query Tips and Examples
Despite no COVID-19 surge this winter, rejection rates for home health referrals have risen to an all-time high of 76%. The increase is due to staffing shortages, reimbursement setbacks, and the fact that patients admitted to home health care tend to have higher acuity. This… Read More »A Look into the Rising Referral Rejections in Home Health
The Centers for Medicare & Medicaid Services (CMS) has recently published a new set of quarterly OASIS Q&As. It includes questions received by the CMS help desks from the first quarter of this year, following the implementation of the new OASIS-E. These Q&As offer valuable… Read More »Eyes Here: April 2023 OASIS-E Q&As
The new OASIS-E emphasizes assessing patients’ cognitive function. Section C provides detailed guidance for evaluating memory, communication skills, and decision-making. The manual also includes tools to identify delirium, such as the Brief Interview for Mental Status (BIMS), which assesses attention, recall, and orientation. This section… Read More »OASIS-E Challenges and Solutions: Section C and BIMS
Knowing the top claims denial reasons from Medicare Administrative Contractors (MACs) is helpful for home health agencies aiming to maintain financial stability and ensure timely reimbursement. By identifying and addressing the root causes of denials, providers can improve their billing and coding practices, optimize cash… Read More »Top Claims Denial Reasons from MACs
