PPS final rule increases agencies’ payments for 2019, finalizes PDGM

CMS has finalized a plan to launch a budget-neutral payment model for home health that utilizes 30-day payment periods and stops using the number of therapy visits to determine payment. That’s according to the 2019 PPS final rule posted Oct. 31 on the Federal Register website.
The Patient-Driven Groupings Model (PDGM) will launch “on or after” Jan. 1, 2020, according to the final rule. That language differs from the proposed rule, when CMS indicated PDGM would …

MedPAC publishes resource for SNFs: Payment basics

By The Bottom Line.
MedPAC released their Payment Basics for SNFs 2018 report, which provides an overview of Medicare coverage and reimbursement. You can download this resource from The Billers’ Association resource library. The report includes a map explaining how reimbursement is calculated under the current prospective payment system, Medicare daily base rates for FY19, and the RUG-IV classification system.
The initial payment rates were set in 1998 to reflect the projected amount that SNFs received in …

Appeals backlog slowly reduced, percentage of unfavorable rulings concerning

By Home Health Line.
While the backlog of home health appeals at the Administrative Law Judge level is steadily being chipped away, data show a low reversal rate for appeals.
In 2018, 54,875 home health appeals have been dismissed. That is compared to 958 dismissals in 2017 and 731 in 2016, according to an analysis from the National Association for Home Care & Hospice (NAHC).
The dramatic jump in dismissed appeals in 2018 is primarily because of large …

CMS publishes corrections to RUG-IV federal per diem rates & MDS item in SNF PPS final rule

By The Bottom Line.
The Centers for Medicare & Medicaid Services published the following summary of errors published in the FY2019 SNF PPS final rule:

In Tables 6 and 7 on pages 39170 through 39172, we made errors in copying values into the “total rate” column of the tables used in the final rule preamble, so the numbers in this column did not accurately reflect the total case-mix adjusted federal per diem rates.
On page 39222, we made …