Revised PBJ methodology and rules impact: Do you know the risks?

2/2/2024 12:00:00 AM Skilled Nursing
Since the advent of Payroll Based Journal (PBJ) reporting by CMS in 2016, facilities have struggled with preparing and submitting accurate PBJ data. Penalties applied for a failure to submit complete and accurate data can result in defaulting to a one-star rating and negatively impacting overall 5-star ratings.

CY 2021 Home Health Final Rule Behavioral Adjustment as Proposed

11/17/2020 12:00:00 AM Home Health
CMS published the CY 2021 Home Health Payment System Rate final rule on November 4th. As it stands, all of the PDGM methodology, the Behavioral Adjustments level, LUPA thresholds and case-mix weights will be kept the same in CY 2021 as they were in the first year of PDGM. With another quarter of data under our belts and with the better understanding and management of COVID-19, Chris Attaya takes a look at several areas of expected PDGM behavioral changes.

CMS releases Home Health Final Rule: PDGM Starts in CY 2020

11/8/2018 12:00:00 AM Home Health
The CY 2019 Home Health Payment System Rate final rule was published last week and, as expected, the Patient-Driven Groupings Model (PDGM) will be implemented for 30-day periods of care starting on or after January 1, 2020. In our blog we provide a summary of changes to the model, such as the expansion of clinical groups from six to twelve, as well as home health PPS Case-mix updates and significant HHVBP changes confirmed in the final rule.

CMS Home Health Proposed Rule shares PDGM winners and losers

9/5/2018 12:00:00 AM Home Health
In the CY 2019 Home Health Proposed Rule, CMS shared a level of detail not seen before – an agency specific list of how agencies will fare under the changes they are proposing. Wow. CMS shared the agency revenue impacts of the Patient-Driven Groupings Model (PDGM) versus the current 153-group PPS reimbursement revenue. The range of the revenue impact is quite wide. Looking at the SHP national database for CY 2017, about 17% of the 3.6MM payment episodes in our database had a primary diagnosis code that would be considered a QE under PDGM.

Home Health CY 2019 Proposed Rule warms over HHGM

7/23/2018 12:00:00 AM Home Health
July usually starts the month off with fireworks, but this year the proposed rule was issued on July 2nd with its own bang at just under 600 pages. The big news - Home Health Groupings Model (HHGM) is now the Patient-Driven Groupings Model (PDGM). Below are a few other highlights from the proposed rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP), new Home Infusion Benefit and the changing HH PPS case-mix weights (CMW).

CMS Open Door Forum concludes a busy news month

3/6/2018 12:00:00 AM Home Health
On February 28th CMS ended the month hosting their regular Home Health Open Door Forum with some very notable updates to the home care industry. With little fanfare and during the Q&A portion, CMS responded to a question regarding the timing of the new OASIS forms as OASIS-D!

What’s next – OASIS-C3 or OASIS-D?

8/15/2017 12:00:00 AM Home Health
The big news in the latest proposed rule for HH PPS was the Home Health Groupings Model (HHGM). Along with the typical recalibration to case-mix payments and case weights, did you see the significant proposals regarding the Home Health Quality Reporting Program (HH QRP)? Almost a third of the 389 pages in the rule were in regard to the HH QRP.

Home Health Payment Groupings Model is gaining momentum

2/2/2017 12:00:00 AM Home Health
On January 18th, CMS presented a slideshow through their Medicare Learnings Network on a possible new payment refinement to home health care reimbursement called the Home Health Groupings Model (HHGM). This was the second call in six months where Abt Associates, CMS’ contractor, shared the HHGM background in addition to the 178 page technical report they issued in November 2016. This sure seems to be picking up speed.

CMS Continues to Surprise

8/5/2015 12:00:00 AM Home Health
The Home Health Proposed Rule was posted by CMS on the Federal Register July 10th and it was full of surprises, especially in light of the much anticipated proposal on Value Based Purchasing (VBP).