Regulatory Compliance
03/14/2019
The Patient-Driven Groupings Model (PDGM) will completely change the way agencies get paid and impact almost all areas of the business, making it crucial for agencies to take steps to ensure they’re ready for the change.
03/14/2019
Before long, codes may exist to capture a patient’s diagnosis of pathological fracture of “other specified site” due to age-related osteoporosis or pathological fracture of “other specified site” due to drug-induced osteoporosis.
03/14/2019
In an effort to streamline its process and increase communication with providers, CMS has rewritten its guidance for surveyors on when and how to determine if an immediate jeopardy (IJ) to patients exists.
03/14/2019
Medicare Administrative Contractor (MAC) Palmetto GBA shared potentially good news with certain providers struggling to achieve success in targeted probe-and-educate reviews.
03/07/2019
by: CMS
The chart below lists the subgroups that lead to high comorbidity adjustments under PDGM. Claims with secondary diagnoses within interacting categories will qualify for a high comorbidity adjustment.
03/06/2019
CMS recently received Paperwork Reduction Act approval for its planned review choice demonstration for home health. Now it’s “finalizing the choice selection process” for agencies, a CMS spokesman tells HHL.
03/06/2019
As the usage of Medicare Advantage (MA) plans has increased, so too have the number of claim denials agencies face. But there are many ways to avoid denials so that the appeal process can be avoided. 
03/06/2019
Following a recent DecisionHealth webinar about the Patient-Driven Groupings Model (PDGM), agencies asked questions of industry expert Robert Markette. Markette is an attorney with Indianapolis-based Hall, Render, Killian, Heath & Lyman.
02/27/2019
Although CMS may make minor changes before the Patient-Driven Groupings Model (PDGM) launches on or after Jan. 1, 2020, the model appears to be largely settled and agencies are now beginning to examine what operations will look like under it.
02/27/2019
New results from CMS’ targeted probe-and-educate review indicate the home health industry has made little or no progress when it comes to improving the quality of documentation Medicare Administrative Contractors (MACs) are seeking.

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