CMS Finalizes Home Health Payment Rule

The Centers for Medicare & Medicaid Services (CMS) finalized the much anticipated Home Health Final Rule October 31.  This rule finalized changes for the Patient-Driven Groupings Model (PDGM) that will go into effect on January 1, 2020.

 

The good news is that, overall, CMS’s final rule for 2020 increases Medicare payments by an estimated 1.3% — or about $250 million. 

 

But perhaps the biggest news for U.S. home health providers is a major update to PDGM’s widely opposed and controversial behavioral adjustment.  In the Final Rule, CMS lowered the behavioral adjustment from 8.01% to 4.36%, which is “a big win for home health” says Mike Dordick, McBee President.  

 

Read the McBee summary of the 2020 Medicare Final Rule for home health agencies.

 

Netsmart and McBee will continue to advocate for the home health industry. Our goal is to prepare our clients for PDGM and help our industry succeed. 

 

You should start preparing for PDGM now. Ensure you have strong co-morbidity and diagnosis coding in place. 

 

To learn about what you need to succeed under PDGM, visit our PDGM resource page here.