Home Health Agency (HHA) Center

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HHAs: Avoid Payment Delays, Register for iQIES by December 23

Act now. Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit assessment data beginning January 1. We will return claims that cannot be matched to assessments, delaying your Medicare payments. See the MLN Connects Special Edition article (PDF) SE 19025 for:

  • Background
  • Step-by-step instructions
  • Training videos
  • Frequently asked questions
  • How to get help

CMS-1711-FC

The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period (CMS-1711-FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2020. The final rule with comment period results in a 1.3 percent increase ($250 million) in payments to HHAs in CY 2020. This rule with comment period also implements the Patient‑Driven Groupings Model (PDGM), a revised case‑mix adjustment methodology, for home health services beginning on or after January 1, 2020. This final rule with comment period also implements a change in the unit of payment from 60‑day episodes of care to 30-day periods of care, as required by section 51001 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) and finalizes the 30-day payment amount for CY 2020. Additionally, this final rule with comment period modifies the payment regulations pertaining to the content of the home health plan of care; allows therapy assistants to furnish maintenance therapy; and changes the split percentage payment approach under the HH PPS. A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2020 HH PPS final rule (click here). View the current HH PPS Grouper Software on the Home Health PPS Software webpage. This final rule with comment period also sets forth routine updates to the home infusion therapy payment rates for CY 2020 and finalizes payment provisions for home infusion therapy services for CY 2021 and subsequent years. 

 

Home Health Patient-Driven Groupings Model: Operational Issues Call– August 21, 2019

  • The presentation (PDF)presentation clarification (PDF), audio recording (ZIP), and transcript (PDF) are available from the August 31 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. During this call, learn information to help your agency prepare to implement billing changes for the Patient-Driven Groupings Model (PDGM) on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.

Overview of the PDGM Model Medicare Learning Network Call – February 12, 2019

Home Health, Hospice and DME Open Door Forum

Physician Certification of Patient Eligibility for the Medicare Home Health Benefit

MLN Connects Newsletter

  • Subscribe now to receive the weekly MLN Connects® newsletter for the latest Medicare Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.

For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.

 

Important Links

Page Last Modified:
10/31/2019 03:45 PM