As we turn the page on the year 2018, the year ahead promises to be another year for home health agencies to buckle down and prepare for major changes and continuation of CMS initiatives to monitor our billing activity and documentation practices.

  • The Targeted Probe and Educate (TPE) program will continue. Some States, like Texas are most impacted. Palmetto GBA reports they performed 562 Probes between 10/1/17 and 9/30/18 with 430 of those being in the Lone Star State. Of the 562 Probes 252 Providers passed Round 1 and 310 were found non-compliant and moved to Round 2. This clearly points out the need for home care agencies to continue to place focus on documentation practices, clinical education and developing effective quality assurance programs.
  • The Review Choice Demonstration Program, slated to kick-off in Illinois in December, has been delayed while the government awaits final approval for the program to clear the Paperwork Reduction Act process. Once cleared Illinois, Ohio, North Carolina, Florida and Texas are scheduled to participate in the Demonstration.
  • The Home Health Value Based Purchasing entered into measurement year 4, and many providers in the nine states participating in that program will see incentives / penalty payment percentages from measurement year 2 affect their Medicare Fee-For-Service payments. The incentive / penalty risk factor is plus or minus 7% in measurement year 4.
  • In the November release of the 2019 Home Health Payment Update, CMS addressed the requirement of BBA 2018 to implement the Patient Driven Care Model (PDGM) and specified that transition will take place on 1/1/2020. This new payment model certainly ushers in the most sweeping changes for how we are reimbursed for services rendered since the inception of Home Health PPS in 2000.

Our industry is resilient! We have faced the consistent challenge of decreasing reimbursements and increasing expectations to document quality patient care. At S.M.A.R.T. we are prepared to work with our current and future clients to achieve success through the challenges.