On November 1, CMS released the CY 2025 Home Health Payment Final Rule. It includes a permanent adjustment of -1.975% to the base payment rate, which is half the total required adjustment (-3.95%) to counter expected PDGM-related behavior adjustment. The… Read More »In Summary: CY 2025 Home Health Payment Final Rule
Claims containing primary diagnoses that do not fall into one of the 12 PDGM clinical groups may be denied by CMS or sent back to the agency with a “Return to Provider” (RTP) remark. Such primary diagnoses are referred to… Read More »Tips to Avoid the Use of Questionable Encounter Codes
The CY 2024 Home Health Final Payment Rule introduces a wave of changes, including updates on the comorbidity adjustments. The final rule reads: “only those subgroups of diagnoses that represent more than 0.1 percent of periods of care and that have… Read More »Comorbidity Adjustment Changes in 2024
CMS released the CY 2024 home health final payment rule last November 1. CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023. The final… Read More »In Summary: CY 2024 Home Health Final Payment Rule
Maintaining a consistent cash flow is crucial for home health businesses dealing with challenges like Medicare payment cuts, regulatory changes, and shifts in the payer mix. A critical aspect of achieving this involves avoiding claim rejections, which can lead to… Read More »How Claims Rejections are Costing You Time and Money
F2F encounters are essential for certifying a patient’s eligibility for Medicare home health benefits. However, complying with F2F documentation requirements has persistently challenged many home health agencies, resulting in frequent Medicare claim denials. F2F guidelines may appear ambiguous making it… Read More »Revisiting the Basics of F2F Compliance
Diagnosis/coding queries are helpful to ensure proper documentation and accurate coding, but getting timely responses from physicians is often challenging. Physicians’ busy schedules make it hard to find a suitable time for discussions. Some may resist or cooperate less when… Read More »Coding Query: Tips and Examples
In certain cases, the ICD-10-CM guidelines require the use of multiple diagnosis codes to report a specific medical condition. This practice goes by various names such as “mandatory multiple coding,” “dual classification,” “dual coding,” or “mandatory dual coding.” An example… Read More »Understanding Etiology and Manifestation Coding
Home health agencies greatly benefit from being aware of the top reasons for claims denials by MACs. It helps save valuable time and resources in rectifying denied claims and reduces the likelihood of receiving Additional Development Requests (ADRs) from CMS,… Read More »Top Claims Denial Reasons from MACs
Accurate and case-specific coding is vital for success under the Patient-Driven Groupings Model (PDGM). It ensures proper payment and addresses patients’ healthcare needs. Submitting claims with coding errors can result in claim returns and long-term consequences. Agencies consistently submitting invalid… Read More »Coding Reminders and Red Flags
