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Agencies shouldn’t lose sight of maintenance therapy in 2020 as the service will continue to play an important role in the care agencies provide under PDGM.
Home health requests for anticipated payment (RAPs) were held by Medicare Administrative Contractors (MACs) in the early days of the new payment model, leaving some agency leaders concerned about timely payment.
As the Patient-Driven Groupings Model (PDGM) gets underway in 2020, many industry experts are concerned that not all agencies will survive the transition to the new payment model.
Agencies need to focus on submitting the OASIS on time to avoid denials or claims getting returned to provider (RTP), resulting in potentially costly delays.
Avoid significantly changing therapy utilization as soon as the Patient-Driven Groupings Model (PDGM) takes effect or risk CMS scrutiny.
Agencies should consider implementing a solid wound care program or improving upon any existing program in light of the Patient-Driven Groupings Model (PDGM).
Under PDGM, agencies won’t be required to discharge a Medicare patient if the patient has an inpatient stay that spans the end of the first 30-day period of care in a certification period.
New guidance from CMS provides direction on which codes should be included on M1021 (Primary diagnosis) and M1023 (Other diagnoses).
The latest release of CMS’s quarterly OASIS Q&As delves into issues around the Patient-Driven Groupings Model (PDGM) and OASIS-D1, providing much-needed guidance for agencies on how to meet CMS expectations for the assessment heading into 2020.
Agencies should take a close look at how they conduct competency evaluations to ensure compliance now that CMS has released changes to existing regulations.


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