ARTICLES

Labor Department Cracks Down on Home Care Providers

April 24, 2019 | Joyce Famikinwa, Home Health Care News

Federal watchdogs continue to ramp up oversight of home care companies for minimum wage and overtime pay violations, a Wednesday report from Bloomberg Law suggests. Meanwhile, caregiver registries are creating uncertainty as to whether they should be considered employers.

Over the past few months, several home care companies across the U.S. have been met with lawsuits from the U.S. Department of Labor (DOL) Wage and Hour Division (WHD). Specifically, DOL is going after home care companies for misclassifying workers as independent contractors and not compensating them overtime payments, according to Bloomberg Law.

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Home Health Physical Therapy Visits May Lower Re-Hospitalization Risk by 82%

April 18, 2019 | Joyce Famikinwa, Home Health Care News

Home health physical therapy sessions — set for major changes under the upcoming Patient-Driven Groupings Model (PDGM) — can drastically lower the risk of re-hospitalization among older adults following discharge.

That’s according to a new study published earlier this month in Journal of the American Medical Directors Association. Specifically, the study found, one to two weekly physical therapy sessions can help lower the chances of re-hospitalization among older adults by up to 82% in a 60-day period.

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Pre-Claim Review Subsequent Episode Checklist

Palmetto GBA

This job aid    (PDF, 76 KB) was created to assist home health providers submitting for Pre-Claim Review (PCR) during the Review Choice Demonstration (RCD) to ensure all necessary documentation is submitted to Palmetto GBA for an initial and subsequent submission.

Note: Providers are able to submit for multiple submissions as long as all Medicare documentation and signature guidelines are met. Please refer to the Internet Only Manual (IOM) for all documentation guideline requirements.

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CMS Releases Additional Instructions for Claims Under PDGM

CMS.gov

The Centers for Medicare & Medicaid Services (CMS) has released a second set of revisions to Chapter 10 of the Medicare Claims Processing Manual providing instructions to home health agencies for claims submission under PDGM. CMS Transmittal 4294/Change Request (CR) 11272, Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions, provides some clarity over the first set of revisions via CR 11081. (See NAHC Report article here.)

https://report.nahc.org/cms-issues-instructions-for-pdgm-claims-processing/

NAHC reached out to CMS with questions that remained after the release of CR 11081. These questions, along with additional revisions to the Claims Processing Manual, have been addressed with the changes outlined in CR 11272. Specifically, the following is clarified:

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CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs

May 9, 2019 | Seema Verma, Administrator – Centers for Medicare and Medicaid Services

At the Centers for Medicare & Medicaid Services (CMS), we are making great progress to transform Medicaid, which CMS’s largest program serving 72.5 millionbeneficiaries. We are working to reset the federal-state relationship and restore the partnership between the states and the federal government, while at the same time modernizing the program to deliver better outcomes for the people we serve.

CMS has made significant improvements in administering the Medicaid program in partnership with states. Identified early as a priority for both the Trump Administration and the National Association of Medicaid Directors (NAMD), I charged a CMS team to collaborate with states to make the state plan amendment (SPA) and 1915 waiver review process more transparent, efficient, and less burdensome so we can reduce processing times. This is particularly important as these represent the bulk of approvals states need to receive to make even routine changes to program benefits, rates, and eligibility requirements. When this process doesn’t work, it can create bureaucratic headaches that hinder their ability to effectively manage their program.

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Home Care Industry Turnover Reaches All-Time High of 82%

May 8, 2019 | Robert Holly, Home Health Care News

The home care industry’s biggest problem — turnover — is only getting worse.

Already cited as the No. 1 challenge plaguing home care agencies across the country, the median caregiver turnover rate skyrocketed to 82% in 2018, according to this year’s Home Care Benchmarking Study by market research and education firm Home Care Pulse.

That mark — a new all-time high — is a 15% increase over the previous year.

“I knew [turnover] was going to go up based on some of the factors we’ve seen over the last year or two,” Home Care Pulse founder Aaron Marcum told Home Health Care News.

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Starbucks, Best Buy, and TripAdvisor Offer Employee Caregiver Benefits. Here’s Why Home Care Agencies Should Care

May 14, 2019 | Bailey Bryant, Home Health Care News

Recognizing the competitive value of home care providers, a growing number of employers in various industries have started offering caregiving benefits as a way to improve workers’ attendance, morale and performance.

While programs vary, they often offer employees a set number of subsidized care days per year — preventing workers from taking time off when their elderly parents, children or even pets need care.

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PDGM’s Co-Morbidity Changes May Trigger Substantial Payment Bump

May 14, 2019 | Robert Holly, Home Health Care News

To fine-tune operations ahead of the Patient-Driven Groupings Model (PDGM) with the hopes of maximizing reimbursement, many home health providers have shifted their referral focus to institutional settings. But there are also substantial dollars tied to patients’ co-morbidities, an idea that has largely fallen by the wayside when it comes to PDGM preparation.

“It’s somewhat of a neglected topic,” David Merk, founder and CEO of Home Health Gold, told Home Health Care News. “There are definitely dollars involved in co-morbidity scoring, however.”

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How Home Health Agencies Can Survive the Review Choice Demonstration

May 20, 2019 | Robert Holly, Home Health Care News

Only 11 days stand between home health agencies and the launch of the dreaded Review Choice Demonstration (RCD) in Illinois. Having quality documentation processes in place and a strong electronic medical record (EMR) partner will be the keys to surviving the upcoming demo, experts caution.

But picking the right claims review option will also be critical to agencies’ RCD success.

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This Critical Combo Could “Blow Up” Home Health Agency Revenue Cycles

June 2, 2019 | Robert Holly, Home Health Care News

The Review Choice Demonstration (RCD) for Illinois home health agencies started on Saturday, with more than three-quarters of providers taking the pre-claim review route.

For the most part, affected agencies have expressed confidence moving forward under RCD, an initiative from the Centers for Medicare & Medicaid Services (CMS) meant to curb improper billing. The bigger concern, agency owners and operators say, is how RCD will play out after the Patient-Driven Groupings Model (PDGM) goes live.

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