Medicare Home Health 2020 Billing

Course overview

Part 1: Intake, Orders, Prebill Audits The Patient Driven Groupings Model (PDGM) became effective on January 1, 2020. This is the most significant change to the home health care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000. The new payment model dramatically impacts agency operations, processes and performance. Home health agencies must develop and implement plans to successfully transition to the PDGM now. This webinar presentation will review key areas, strategies, and processes in preparing an agency for the PDGM. The speaker will focus on the changes to the 30-day payment model, which will bring significant back office changes, specific to the claims processing and collections. Part 2: Billing & Collections RAPs & Final Claims The PDGM brings many changes to the billing process, including doubling 75% of the volume of claims for current Medicare episodes compared to 2019 that will be sent, as well as multiple changes to claims data. With RAPs (Requests for Anticipated Payment) and final claims now required every 30 days instead of 60 days, agencies may need to expand their revenue cycle teams. This webinar will cover details regarding the actual billing changes that will need to occur under the PDGM. We will take you through the details of billing under the PDGM and will review the process that the Medicare Administrative Contractor will go through to calculate the HIPPS code and pay claims. Lastly, this webinar will cover the proposed changes from a RAP to NOA (Notice of Admission) for 2021. There will also be a discussion of the overall impact on the revenue cycle under the PDGM.