Kenyon HomeCare ConsultingNavigating The Final Rule: Let's Look At Some Changes And Positives From Home Health Regulation Changes! - Kenyon HomeCare Consulting (206) 721-5091

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Navigating The Final Rule: Let’s Look At Some Changes And Positives From Home Health Regulation Changes!

Home Health RegulationsWhether you are a brand-new skilled agency or have been in business for decades, the final rule always makes you cringe a little. Home health regulations can be overwhelming when it comes to implementing them. The industry saw many changes in this final rule. Let’s look at some of them. 

Here Are Some Good Things: 

If it seems there isn’t anything good there, then you should take another look.  Here are 5 things that came from proposed home health regulation change in favor of the good guys! 

  • Home Health Gets A Raise: The standard 60-day episode payment increased 2.2%. Neutrality factors included, the average payment per episode is up. 
  • Physician Certification: The plan of care and additional supporting documentation determines eligibility. If signed and dated by the MD containing all necessary elements, then it is sufficient.
  • Recertification: Length of time estimation is eliminated. Good! This is just extra paperwork and time for the agency and the MD.  
  • Telemedicine: The cost associated with remote monitoring can be an admin cost on cost report. It does not mean additional reimbursement. It does not mean substitution for home health visits, but it does mean accounting for the cost. 
  • RAP Payments: RAP payment will continue to exist for established home health agencies. 

Areas Of Concern For The Industry: 

For everything that is positive with the regulations, there are also areas of concern. Here are 3 things with considerable impact: 

  • Patient-Driven Groupings Model: This is a revised HHGM model. It contains the 30-day periods of billing within your 60-day episode. There are 432 payment groups and it eliminates the therapy volume domain. It will consider timing, admission source, 6 clinical groupings, functional level, and co-morbidity adjustments. There are adjustments up to -6.42% based upon LUPAs, coding, and co-morbidities. Number of agencies are anticipated to decrease in certain regions. 
  • Rural-Add On: The add-on percentage will continue to decrease each year. Add-on is 3 different sub-categories: Low Population Density Agencies, High-utilization counties, and all other rural areas. 
  • Home Infusion Therapy Benefit: These services are provided under Part B and not the home health benefit.  The new considerations are only for certain drugs and only with use of an infusion pump in the home.  If Part A providers adhere only to what the Part B provider allows, then patient care could suffer. There could be side-by-side billing, but what if overlap of nursing care exists? If the patient needs to be taught the infusion, then also needs wound care? It just needs additional clarification so there is no chance of incorrect billing. 

Do Your Homework And Call Us If You Need Help: 

At Kenyon Homecare Consulting, we have seasoned consultants from top administration levels. We help navigate operational changes and work with you through changes. Call us at 206-721-5091 or contact us online for assistance. 

Category: Legislation/Reform, Regulatory Compliance

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