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Pre-Claim Review Non-Affirmations

You are already familiar with the Home Health Review Choice Demonstration and Home Health Pre-claim Review Submissions. Recently, PalmettoGBA (PGBA) released some important information regarding Pre-Claim Review (PCR) Non-Affirmations that pertains to home health agencies in Illinois and will soon apply to Ohio agencies as well. This is valuable insight into what PGBA is looking

2020 Medicare Home Health PPS Proposed Rule

This home health proposed rule’s 346 pages (reduced from last year’s 600) were published on July 18. Comments will be accepted from now until September 9, 2019. You can submit your comment by clicking on the “Submit a formal comment” link near the top of the article. You can also send your comments by regular

Home Health Review Choice Demonstration

The Review Choice Demonstration (RCD) is a home health review program. It is planned for a 5-year period with initial implementation in Illinois scheduled for June 1, 2019 and expansion into Ohio, North Carolina, Florida and Texas soon after. This program is a continuation of CMS’s efforts to crack down on fraud, waste and abuse

PDGM Explained

The Patient-Driven Groupings Model (PDGM) is an alternative payment model that will replace the home health Prospective Payment System (PPS). The planned implementation date is January 1, 2020. Why the change? The Bipartisan Budget Act of 2018 (BiBA) requires reform of the current payment model to address several perceived problems in the PPS home health

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