Understanding the 2020 PPS final rule

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.

Ask the Experts: Home Health & Hospice Coding

As one of the oldest and most respected names in home health and hospice consulting and services, Fazzi’s goal is to improve quality, productivity, efficiency, and patient and family satisfaction through consulting, education, and outsourced services. To do this, we’ve launched our Ask the Experts webinar series.

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.

Whether or not your agency has a coding expert on staff, your team is likely hungry for additional information as new regulations impact coding processes regularly. Now is your chance to have those questions answered.

Targeted Probe and Educate in Hospice – Learn How to Prepare

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

What the FY 2020 Proposed Rule Means for PDGM and Coding

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.


Understanding the Hospice Final Rule

Fazzi has partnered with WellSky to present this free webinar.

The Centers for Medicare & Medicaid Services (CMS) have published the 2020 Hospice Final Rule, which includes a significant rebasing of hospice payment rates. Rates for higher acuity levels of care are increasing, while rates for routine home care are decreasing. The 2020 final rule also includes a complex new requirement for an addendum to election statements that must provide details as to the care, services, and drugs that will not be covered under the Medicare hospice benefit.

Implementation of the election addendum has been delayed until October 2020, but other provisions of the 2020 hospice final rule go into effect on October 1, 2019, so your time to prepare is very brief. The time to begin is now.

In this important 60-minute presentation, Catherine Dehlin, RN, BSN, CHPN, CHCM, Director of Hospice Services for Fazzi Associates will help you understand the new requirements, evaluate their impact on your processes, and create an action plan to succeed.

 Watch to learn:

  • How rebased payment rates for CHC, IRC, and GIP levels of care will affect your hospice
  • Why rebased payments may signal a new level of compliance scrutiny for hospices
  • The new requirements for an addendum to the hospice election statement


PDGM Readiness Webinar Recording: Clinical Groupings, Case Management and LUPAs

Under PDGM, it is critical that you fully understand the clinical groupings, how they impact case mix and, of course, reimbursement. Also, best practice case management including efficient visit utilization and managing LUPAs will become even more important in the new world.

Join PDGM industry experts Gina Mazza and Cindy Campbell as they explain, discuss and provide insights about:

  • The Clinical Groupings component of the PDGM case mix
  • Key concepts for best practice case management
  • Effective approaches for efficient visit utilization including managing LUPAs

Continue reading “PDGM Readiness Webinar Recording: Clinical Groupings, Case Management and LUPAs”

PDGM – It all Starts Here: Referrals and Intake

Are you aware of the case mix adjuster that’s tied to referral source under the new Patient-Driven Groupings Model (PDGM)? Do you know your referral source mix and, the impact it will have on your reimbursement under PDGM? In this complimentary webinar learn about the admission source and timing components of the PDGM model and, the best practices for the intake, liaison and sales staff that you’ll want to start now. Plus, capturing accurate and specific information at admission is critical to assist clinicians with care planning, accuracy of primary and secondary diagnosis and the entire revenue cycle.

Join us to:

  • Understand what you and your intake, liaison and sales staff need to know now about the PDGM structure related to admission and timing.
  • Understand how to improve the working relationship between your clinical, intake and sales teams.
  • Identify the steps to take now to change your referral source mix.

Gina Mazza and Eileen Freitag provide their best practice recommendations for referral, marketing and intake to position your agency for success under PDGM.

Continue reading “PDGM – It all Starts Here: Referrals and Intake”

Hospice SIA and Best Practices for Quality End of Life Care

CMS created the Service Intensity Add-on (SIA) in recognition of patients and families needing more intensive care and services during the last seven days of life, and that hospices must be reimbursed for these very important services. However, two years after the 2016 Hospice Payment Rule instituted the SIA, it is clear that many hospice organizations have not optimized it.

Catherine Dehlin, Fazzi’s Director of Hospice Services provides a more complete understanding of the benefit and best practice strategies to help ensure patients and families receive high quality end of life care. You’ll receive specific and actionable recommendations in these areas:

  • Direct care
  • Scheduling and staffing
  • Escalation of services
  • Care planning
  • Interdisciplinary team communication
  • QAPI

Continue reading “Hospice SIA and Best Practices for Quality End of Life Care”

PDGM Readiness: What About Therapy?

One of the biggest questions about the Patient-Driven Groupings Model (PDGM) on everyone’s mind is “what about therapy?” While the new model eliminates the therapy thresholds for payment, PDGM case mix includes mechanisms to include all disciplines.

In our complimentary PDGM Readiness webinar, Gina Mazza and Kerry Termine explain how therapy will be reimbursed in the PDGM case mix structure — and provide best practices for providing high quality patient-centered therapy services under this payment model.

Continue reading “PDGM Readiness: What About Therapy?”

PDGM Readiness. The Journey Begins

CMS has issued the Final FY 2019 Home Health Payment Rule, and our industry’s journey to the new Patient-Driven Groupings Model (PDGM) has officially begun.

Two significant changes in PDGM from the proposed rule are:

  • The implementation date is set for “on or after” as opposed to “on” January 1, 2020.
  • CMS has increased the number of primary diagnosis clinical groupings to 12 (from six) by splitting Medication Management Teaching and Assessment (MMTA) into subgroups. This change has doubled the number of HHRGs to 432.

Presenter Gina Mazza discusses PDGM, key changes from the proposed rule and insights on what leaders should do next.
Continue reading “PDGM Readiness. The Journey Begins”