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Preparing for PDGM Like a Pro

If you’re a home health agency, you probably have January 1, 2020, circled on your calendar. Not because it’s the start of a new year, but because that’s the day the Patient-Driven Groupings Model (PDGM), the new Centers for Medicare & Medicaid Services (CMS) payment model, takes effect.

If you haven’t yet drawn up a strategic plan or begun preparing for PDGM, you may be feeling a bit overwhelmed. But you're not alone and it's not too late to get started. Even for those HHAs that are deep into their plans and preparations, PDGM is raising uncertainty and presenting challenges. 

What Is PDGM and What Will it Mean for Your HHA?

If you’re a home health agency (HHA), the Patient-Driven Groupings Model (PDGM) and its January 1, 2020, deadline have probably been on your mind a lot lately. And for good reason – analyst and investment firm TripleTree has called it “the most significant regulatory and reimbursement reform since the creation of the Prospective Payments System (PPS) 20 years ago.”

You may feel a little frazzled or confused by PDGM and the changes it will bring starting in 2020, but don’t hit the panic button. First, you should know what PDGM is and what it’s expected to do. Required by the Bipartisan Budget Act of 2018, PGDM was developed to improve reimbursement for all types of patients eligible for home health benefits and remove perceived incentives to over-provide therapy services, according to Home Health Care News.

Home Health and Hospice: Looking Ahead to 2019

As we wrap up this year’s National Home Care and Hospice Month celebration, we’re looking ahead to 2019 and the industry changes the new year will bring. In this blog post, we’ll dive into those changes and regulations that will undoubtedly impact your organization.

The Return of Pre-Claim Review - What We Know

**Update - April 3, 2018: CMS announced that Review Choice Demonstration will begin on June 1, 2019. The choice selection process for HHAs in Illinois begins on April 17, 2019 and ends on May 16, 2019.

In 2016, CMS began rolling out a pilot program to enforce a more proactive oversight strategy on Medicare home health claims in an effort to reduce fraud and waste. The ultimate goal was to reduce improper payments and the cost of additional documentation and resources it takes for CMS to chase them. This "Pre-Claim Review" demonstration subjected home health agencies to additional billing scrutiny and red tape. 

Home Health Analytics - Why Data Matters

You probably hear this all the time: regularly checking your data is important. You'd better keep an eye on your metrics! In-depth analytics are crucial to keeping your agency going! Business, numbers, etc.

Using Social Media to Improve Your Home Health Agency

With 70 percent of the U.S. population having at least one social media account, you can bet social media is an effective tool to promote a home health agency. eSolutions has a few tips for social media beginners and advanced users alike that may help you boost your online presence and attract home health agency clients.

Battling Medicare Secondary Payer Claims

Medicare Secondary Payer (MSP) is the term used when Medicare is not the primary paying party. Heartache swirls around MSP claims for a variety of reasons, mainly because these claims are complex, need manual work and take the time from your busy billing team that it doesn't have.

Managing Home Health ADRs for Optimal Reimbursement

In our last blog post, we outlined common causes of Additional Development Requests (ADRs) and offered tips to prevent them. We even included a special home health agency final claim checklist to help you submit an end-of-episode claim correctly to avoid an ADR and speed up reimbursement.

Prevent Home Health ADRs before they Cost You Time and Money

Additional Development Requests (ADRs) are a fact of life for home health agencies. Since CMS renewed its Probe and Educate, now called Targeted Probe and Educate (TPE), preventing ADRs and responding to them in a timely fashion is even more important to the financial health of your agency.

Infographic | Top 6 Home Health Denial Reasons Based on Medical Review

Accuracy and oversight matter in home health billing. Agencies must be on top of their business practices to avoid denials. This includes managing detailed documentation procedures and the most accurate billing processes possible. Knowing the top reasons home health agencies receive denials based on medical review and how to avoid them will keep your agency on top of its reimbursement game. Check out our infographic to learn more.