In our last post we discussed the Patient Driven Groupings Model (PDGM), an overhaul of the way home health providers are paid by the Centers for Medicare and Medicaid Services (CMS). The new billing model creates hundreds of new categories for home health services, and implements a 30-day billing cycle to replace the current 60-day cycle. It also changes the way providers are assessed Low Utilization Payment Adjustments (LUPAs), and uses “behavioral assumptions” to identify providers that might structure services to maximize billing.
Last year, the Centers for Medicare and Medicaid Services (CMS) proposed a new billing model for home health services that would adjust payments based upon “behavioral assumptions” as opposed to actual provider billing or evidence of changes in billing behaviors. The Patient Driven Groupings Model (PDGM), slated to go into effect Jan. 1, is expected to reduce payments for home health services by 6.42 percent in 2020 alone — an estimated $1 billion.