Final Home Health Rule Cements PDGM, Allows PTAs to Perform Maintenance Therapy

When it comes to its most talked-about provisions, the US Centers for Medicare and Medicaid Services’ (CMS) final rule for home health payment under Medicare isn’t much of a change from the proposed version released earlier this year, meaning that an entirely new payment system will indeed be rolled out beginning January 1. But other parts of the rule have been tweaked—and in several areas, those tweaks represent wins for the physical therapy profession and the patients it serves in home health settings.

It’s official: PDGM is on for 2020.
There wasn’t much debate about whether this would happen, but the final rule eliminates any doubt: the Patient-Driven Groupings Model (PDGM) will be the system under which CMS pays home health agencies (HHAs). It’s a big change, and APTA offers extensive information on the details of the model, but the bottom line is that the PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. The system classifies episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. CMS says it will monitor how HHAs are operating under the PDGM, including the provision of therapy services.

Full story at APTA

ICD-10 Testing Rates Improve, CMS Offers Concession for Certain Coding Errors

As the October 1 startup date for the ICD-10 coding system creeps closer and closer, the compliance picture seems to be brightening, just as the US Centers for Medicare and Medicaid Services (CMS) announces that it’s taking a somewhat softer approach to how it will handle provider mistakes in the new system.

Recently, CMS announced that during the last round of “end-to-end” testing of ICD-10 June 1-5, 90% of claims filed were accepted. This acceptance rate was up from the 88% mark achieved during the second testing phase, and from the 80% figure achieved during the first week of testing.

Full story of concession for coding errors at APTA