PDGM is a major regulatory change that will impact every aspect of your agency. As each department prepares for inevitable changes, it’s important to ensure your agency is on track as whole.
To do this, you must prioritize tasks. To help prioritize tasks, it’s important to understand where you should focus your resources. Fazzi’s PDGM timeline can help you do just that.
Download the tip sheet to learn:
- Why department specific team meetings will help your team prepare for PDGM
- Why December 27th is a date that should be on your agency’s radar
- What coding best practices should be in place for your agency’s success
The 2020 PPS final rule was posted to the Federal Register confirming plans to implement the Patient-Driven Groupings Model (PDGM) beginning January 1, 2020.
The good news is that CMS has cut back on plans to implement an 8.01% decrease in agencies’ payments. Instead, they are finalizing a 4.36% decrease based on assumed behavioral changes and have made some other small revisions. Most other updates, including the elimination of therapy thresholds as a factor of payment, the move from 60 day episodes to 30 day payment periods, and the factors determining case-mix and clinical groups will remain the same. Agencies can click here to review the final rule.
Join Fazzi for a free webinar session where we will:
- Review key concepts as described in the final rule with Fazzi expert Gina Mazza, MBA, RN, BSN, Senior VP of Quality and Compliance, as she discusses finalized guidance regarding PDGM.
- Provide participants with concrete strategies to prepare for PDGM and be ready for implementation on January 1st.
- Hear from one agency as they discuss what their organization is doing now to prepare and services they are using to ensure they are PDGM ready on day 1.
The Home Health Compare results were updated on October 30, 2019.
For the Quality of Patient Care measures, 10 measures improved and 4 remained the same. Improvement in management of oral medications saw the most improvement of 0.9% and improvement in bed transfer improved by 0.8%. (Data Collection January 1, 2018 – December 31, 2018).
Acute care hospitalizations and urgent, unplanned care in the emergency room both improved at 15.6% and 12.8%. (Data Collection January 1, 2018 – December 31, 2018).
The national average for the Quality of Patient Care Star Rating remained the same at 3.5 stars.
HHCAHPS measures also updated and the national averages remain the same for all 5 measures. The data collection period for these measures and the Star Ratings is April 1, 2018 – March 31, 2019.
To see where the 5 star agencies are located, visit our Home Health Compare page and use the drop down for Star Ratings at the agency level. You can also compare measures by state, by year, by release date, and the top 10 or top 20 percent.
The Centers for Medicare & Medicaid Services (CMS) issued the 2020 final rule on October 31, reinforcing the plan to implement the Patient-Driven Groupings Model on January 1, 2020. With PDGM just 60 days away and so much to do in so many departments, it can be hard to know what tasks should be prioritized over others.
To help prioritize tasks, it’s important to understand where you should focus your resources. Fazzi’s PDGM timeline can help you do just that. Download the tip sheet to learn:
- Why you should focus on referral and intake workflows
- Why developing a Significant Change in Condition Policy is important
- What you should be doing to ensure your software is PDGM ready
PDGM is quickly approaching. To prepare, home health agencies will need to make significant changes to their operations. Failure to adapt and respond to these regulatory changes put agencies’ revenue at risk from both a reimbursement and profitability perspective.
PDGM will illuminate the need for strict compliance and accuracy when submitting claims.
Download this free white paper to learn more about the three broad areas agencies must address to successfully manage claims to ensure proper reimbursement under PDGM. The areas addressed in this white paper include:
- Recognizing the twelve clinical sub-groups and unacceptable primary codes
- Identifying common home health codes under each sub-group
- Understanding the steps to prepare coders for PDGM coding
Coding is one of the most important aspects of your agency’s operations. Errors in coding can cause delays in reimbursement, or worse – denials. Reimbursements are the key to financial stability, and this stability allows you to deliver care at the highest levels.
Fazzi has partnered with WellSky to present this free webinar.
As the regulatory scrutiny of hospice care continues to intensify, Medicare Administrative Contractors (MACs) are identifying hospices for Targeted Probe and Educate (TPE) in record numbers. While the Targeted Probe and Educate program is intended to impact providers (and ultimately patient) in positive ways, these reviews can be time consuming, challenging, and stressful for hospice leaders. How will you prepare if your hospice is identified for a TPE?
In this important 60-minute presentation, Catherine Dehlin, RN, BSN, CHPN, CHCM, Director of Hospice, will help you understand TPE and learn how to get the most out of this important process.
Attend and learn:
- The rationale and objectives of TPE in hospice
- The typical TPE process for most MACs and the ideal response for hospice providers
- The aspects of hospice performance that agency leaders should monitor regularly
Don’t miss this opportunity for you and your team to learn from one of hospice’s most influential thought leaders!
View On-Demand Now
One of the many sweeping changes under the Patient-Driven Groupings Model (PDGM) is the move to 30-day payment periods. Diane Poole, long time industry expert and the Director of Fazzi’s outsourced billing department, has created a position paper to address the implications of this change on billing capacity and cash flow. Specifically, in this position paper you’ll learn:
- Predictions on increased claim submissions by agency size (based on CMS data) and how that impacts the associated workload in your billing department.
- The impact on cash flow from “Half the RAP”.
- How Fazzi will help our outsourced billing clients with these challenges.
Continue reading “How Many More Claims Will You Need to Bill Under PDGM?”
CMS has issued the FY 2020 Proposed Medicare Home Health Payment Rule which of course encompasses far more than the proposed payment rates. In particular, the industry has wondered what, if any, changes CMS would make to the Patient-Driven Groupings Model (PDGM) set to go into effect on January 1.
In this complimentary webinar, we provide an update on the portion of the Rule that encompasses PDGM and in particular what we believe to be the impact on agencies’ coding operations, challenges and imperatives.
CMS posted the quarterly Hospice Compare refresh of quality data on August 15, 2019.
All quality measures improved since the last quarterly posting or stayed the same. Pain Assessment and Composite Process Measure showed the most improvement each with a 1.1% increase. Pain Assessment improved from 89.2% to 90.3%, and Composite Process Measure, from 85.3% to 86.4%.
A new quality measure, Hospice Visits When Death Is Imminent, has been added and posted at 82.3%. This measures the percentage of patients getting at least one visit from a registered nurse, a physician, a nurse practitioner, or a physician assistant in the last 3 days of life.
Updates to the family caregivers’ survey results showed all eight measures remained the same.
Quality measure results are from data collected October 1, 2017 – September 30, 2018, and Hospice CAHPS® survey results reported October 1, 2016 to September 30, 2018.
VIEW STATE LEVEL HOSPICE COMPARE CHARTS