November 2018 Industry News

Denials from Medicare Advantage Plans

  • Original article posted on CAHSAH’s Weekly Update on 10/22/18
  • Click HERE to read the Office of the Inspector General’s Report


The Office of the Inspector General reports that Medicare Advantage plans are improperly denying insurance claims. According to the report, Private Medicare Advantage plans have an incentive to deny claims in order to increase their profits. Providers are encouraged to appeal the denied claims since evidence shows that those who appeal are often successful.

Ensure your claims are submitted on time, and your denials are appealed when available. Take advantage of our PPS Billing and Revenue Recovery Services today!

Click here for our PPS Billing and Revenue Recovery Services

CMS Releases Final Proposed Health Payment Rule along with Major Payment Remodel

  • Original article posted on CAHSAH’s E-Alert on 11/01/18
  • Click HERE to read similar article on Tim Rowan’s Home Care Technology Report


The Final Payment Rule for Home Health 2019 payment rates includes a new Medicare Home Health Services payment model that will start in 2020. This model is entitled the Patient-Driven Groupings Model (PDGM). The highlights of the Final Home Health Payment Rule are as follows:

  • Increases 2019 Payment Rates by 2.2%
  • Adjusts 2019 rural add-on amount depending on if it is in a frontier area or high utilization area
  • Includes outlier eligibility at a ration that dropped to 0.51% from 0.55%
  • Creates 30 day payment units beginning on January 1, 2020
  • Eliminates therapy thresholds
  • Creates new case mix adjustment model with 432 categories
  • Includes assumption-based behavioral adjustment to base rates to account for dx coding and visit volume changes. Proposed rule states 6.42% adjustment.
  • Budget neutral rate setting except for behavioral adjustment
  • Bundles payment for both services and non-routine supplies
  • Includes 30-day LUPA range from 2-6 visits
  • Ends RAPS for new home health agencies
  • Creates new home infusion therapy benefit
  • Eliminates paperwork requirement that certifying physician has to state how much longer care is required
  • Permits incorporating home health information into physician’s patient record
  • Makes OASIS refinements that reduce paperwork


Take advantage our Coding, OASIS Review, and 485 Preparation to ensure accuracy and proficiency in your Coding and Clinical Documentation.

Opioid Disposal Legislation Signed

  • Click HERE to read article written by Republican Policy Committee


President Trump has signed into law H.R. 6, which will permit hospice providers to dispose of unused opioids that are no longer necessary. This is often times necessary if the patient has died or the medication has expired. If the employee disposing of the medication is also the physician, he/she may dispose of such controlled medications in cases where the plan of care has changed and the patient no longer needs the medication. A hospice must have written policies and procedures for assisting in disposal of controlled substances and when the controlled substances are first ordered:

  • Provides a copy of the policies/procedures to the patient/family
  • Discusses with the patient/family in a language they understand
  • Documents in the clinical record that the policies and procedures were supplied and discussed
  • Document the type of substance, dosage, route of administration, and quantity
  • Document the time, date, and manner which the disposal occurred

Top 10 Reasons Caregivers Leave Home Care Agencies

  • Original article posted on HCLA’s HomeCare News Alert on 10/23/18
  • Click HERE to read similar article posted by Home Health Care News


There are a lot of reasons that caregivers will leave home care agencies, but it’s best to focus on those that are in your control. The current caregiver turnover rate has climbed between 40-67% with most caregivers retained for half a year or less. The following are the top 10 reasons caregivers leave, according to research from Home Care Pulse:

  • Poor Communication
  • Hours & Scheduling
  • Pay & Benefits
  • Little or No Training
  • Lack of Recognition
  • Lack of Expectations with First Client
  • Lack of Client Compatibility
  • Rude Office Staff
  • Lack of Openness to Ideas or Feedback
  • Commute or Travel


Avoid the extra costs and high turnover by utilizing our Staffing Services. Call us today to find out more (800) 4SYNERG.