Tag: HHAs

The New Postacute Care Payment Systems: 5 Tips to Help You Find Your Way

There’s no doubt about it: the new payment system that the US Centers for Medicare and Medicaid Services (CMS) put in place in October for skilled nursing facilities (SNFs), and the system that will start up for home health agencies (HHAs) on January 1, 2020, represent major changes by Medicare. And like most major changes, the new approaches have sparked myths, misunderstandings, and inaccurate interpretations—sometimes at the expense of physical therapists (PTs) and physical therapist assistants (PTAs) who work in the SNF and HHA settings and their patients.

Discussions on what would become the new systems—the SNF payment model is called the Patient-Driven Payment Model (PDPM) and the HHA approach is known as the Patient-Driven Groupings Model (PDGM)—began 3 years ago, and APTA immediately began a dialogue with CMS that continues to this day. Those interactions, fueled by strong grassroots efforts among APTA members and other stakeholders, have helped to shape final rules that are far from perfect but significantly less problematic than many of the early proposals from CMS.

Full story at APTA

CMS Puts the Brakes on Unpopular ‘Pre-Claim’ Demonstration, Delays Conditions of Participation Update for Home Health

Good news for home health agencies (HHAs) and the physical therapists who work in those settings: the Centers for Medicare and Medicaid Services (CMS) is suspending its plans to expand a required pre-claim review process and is putting its sole demonstration on hold in Illinois for at least 30 days. The agency has also decided to hold off on implementing revisions to conditions of participation for HHAs.

The announcement from CMS arrived just as the agency was scheduled to include Florida as the second state in a 5-state audition of a system requiring HHAs to submit supporting documentation for services while beneficiaries are receiving care. The proposal was largely opposed by HHA organizations, who view the requirement as an excessive administrative burden. CMS announced the suspension on March 31, 1 day before HHAs in Florida were set to begin the pre-claim demonstration.

Full story of a required pre-claim review process at APTA

CMS Will Shift Home Health Agencies to a ‘Pre-Claim Review’ Model in 5 States

In a step that it hopes will help educate home health agencies (HHAs) and prevent improper payment, the Centers for Medicare and Medicaid Services (CMS) will soon require HHAs in 5 states to participate in a pre-claim review process for their Medicare patients.

Beginning with Illinois on August 1, 2016, CMS will require HHAs to submit supporting documentation for services while beneficiaries are receiving care. CMS will review the pre-claim and make a review decision “generally within 10 days,” according to a CMS fact sheet. The other 4 states—Florida, Texas, Michigan, and Massachusetts—will be phased into the program during the rest of the year and into 2017.

According to CMS, the documentation will be “the same type of documentation [HHAs] currently gather for payment, only HHAs will submit it earlier in the process.” The new program does not change eligibility standards, and CMS states that it will allow HHAs to submit additional pre-claim documentation to support the claim should CMS find the initial submission lacking. HHAs can receive initial payments before CMS makes its pre-claim review decision, and if a claim is not approved during the pre-claim process, the HHA can appeal.

Full story of home shift agencies and ‘Pre-Claim Review’ model at APTA