Questionable Encounters are primary diagnosis codes that are not specific enough to support the need for home health services that result in a return to provider (RTP) and ultimately delays in payment.
The Centers for Medicare & Medicaid Services (CMS) issued the CY 2020 Home Health Prospective Payment System Rate Update, which finalized changes for the Patient-Driven Groupings Model (PDGM) that will go into effect on January 1, 2020.
As the Patient-Driven Groupings Model (PDGM) is approaching, organizations are currently focusing on how it will impact revenue cycle functions. To prepare financially prior to PDGM’s implementation date of January 1, 2020, home health organizations can focus on cash collections to be prepared for any loss or delay in cash flow due to the significant changes under the new model and identify risks that could cause potential delays across the revenue cycle.
Home health organizations depend on their staff and tracking systems for a quick and efficient order management process. Order management is a key component within the revenue cycle process, as the collection of physician documentation is required to initiate any billing process. A bill cannot be generated without first obtaining all necessary orders.
For home health organizations, referral and intake directly impact an agencies core operations and ability to provide appropriate care and bill in a timely manner. PDGM adds a new layer of complexity to this process by introducing the 30-day billing periods and admission source.
In the 2020 Patient-Driven Groupings Model (PDGM) environment, LUPAs will become even more complicated with the introduction of the multifaceted structure of visit requirement variables. Like so many other aspects of PDGM, this change in calculation requires your attention.
The Patient-Driven Groupings Model (PDGM) is the most significant change to the home health payment reform in the past two decades. The impact from PDGM is expected to significantly shift service delivery and will change the structure of home health reimbursements. A key component for calculating payment under PDGM...
The Patient-Driven Groupings Model (PDGM), is the most significant change to the home health payment reform in the past 20 years. PDGM completely alters the methodology for calculating payments, and an example of this is the removal of therapy utilization as a component and the payment periods have been reduced from 60 to 30-days...
More than any of the very complex modifications contained in the Patient-Driven Groupings Model, the most important enhancements emphasize the dire need for all agencies to have a solid and well-functioning episode management program in place before January 1, 2020.