By Andrew
Donlan | March 3, 2020
Under
the Patient-Driven Groupings Model (PDGM), 80% of home health agencies are
experiencing a difference in reimbursement compared to the old Prospective
Payment System (PPS). Of those, the vast majority — 82% — are experiencing a
decrease in reimbursement.
That’s
according to a recent survey of 127 home health agencies conducted by
information technology firm Ability, an Inovalon company.
Although
a significant portion of providers said their reimbursement rates have gone
down in the early days of PDGM, 54% of surveyed agencies said the decrease was
merely “moderate.” David Swenson, a sales engineer at the Ability, discussed
the findings Tuesday during a webinar hosted by HHCN.
Apart
from the survey results, the transition to PDGM appears to be going smoothly
overall, at least compared to the occasionally rocky road that skilled nursing
operators faced with their own Medicare reimbursement overhaul.
Medicare
Administrative Contractors (MACs) are processing claims timely and with little
disruption. Additionally, PDGM’s cash-flow projections have largely
played out as expected, according to Brian Harris, consulting director at
BlackTree Healthcare Consulting.
“There’s
really a lot of positive news here,” Harris said, also speaking during
Tuesday’s webinar. “In a lot of the lead-up to PDGM, there were concerns about
how Medicare was going to adapt to the change, how their systems were going to
process claims. And across all MACs throughout the country, we’re really seeing
them operating under the standard pre-PDGM claims processing timelines.”
That
isn’t always true, as Harris noted there have been hiccups here and there, such
as a small amount of claims being held up in manual processing for up to 30
days. But generally, industry outlook is positive through PDGM’s first 60 days.
“For
the most part, we’re seeing those final claims come in and pay at that 10 to 14
[day] timeline, with RAPS (Requests for Anticipated Payment) in that seven- to
10-day timeline,” Harris said. “And generally claims seem to be paying at the
reimbursement rates that are expected.”
Home
health providers also seem to be finding success in minimizing PDGM’s
Questionable Encounter (QE) risk. Broadly, QEs are primary diagnosis codes that
are no longer reimbursable under PDGM.
After
the first week of 2020, industry analyses showed that 6% of home health periods
were still under QE status. While low, that was a surprising percentage
considering all the educational efforts that took place in 2019, Harris said.
“That’s
definitely an improvement [over what] CMS estimated, but being that this was a
huge topic of conversation going into PDGM and a big area of concern, we
expected providers to be leveraging their EMRs … to really get out ahead of
[this].”
Since
Feb. 18, however, that QE percentage has decreased to 0.5%, suggesting home
health providers are adapting quickly.
In
addition to the previously mentioned findings, the Ability survey of 127 home
health providers also found that 84% of agencies are submitting more claims per
month. Specifically, mid-sized agencies have reported submitting an average of
110 claims per month.
As more
and more data is available from the first year of PDGM, both good and bad
trends will become more apparent. For example, it’s still too early to tell if
the overhaul has triggered an over-correction to therapy utilization or a
drastic shift away from community referrals.
No comments:
Post a Comment