Home Health|Hospice Articles and Resources

Important News and Information

PDGM Calculator for Home Health: Reminder, CMS has changed the unit of the home health payment from a 60-day episode to a 30-day period. When using the calculator, be sure that you enter the “Number of Visits” based on 30 days instead of 60 days. Read the entire article.

Definition and Uses of Health Insurance Prospective Payment System Codes (HIPPS Codes)

Who Qualifies for Chronic Care Management Services

Home Oxygen Therapy

What Is PDGM and What Will it Mean for Your HHA?

Code Sets

CPT Codes

CPT Procedure Codes

ICD-10-CM Codes

ICD-10-CM Diagnosis Codes

Find-A-Code's Tools & Resources

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Click-A-Dex™ Index Search Tool

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Step-by-step coding from all major code sets.

NCCI Edits Validator

Validate using NCCI edits for errors in code selection.

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Verify Medicare Reimbursement and UCR Fees for Professional Services

Commercial Payer Policies

View Clinical Indications for Medical necessity on procedures, Suggested Code Selection to assist your clinical judgment includes citations.

Find-A-NPI™

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HIPPS (PDGM/HIPPS) Calculator

Use this calculator to find a HIPPS code and estimated payment based on the Home Health PDGM

Additional Links and Resources

Medicare Home Health Benefit

Medicare Home Health Benefit

MLN Catalog

Brief descriptions and links to trusted MLN educational resources.

Patient Driven Groupings Model (PDGM), eff 01/01/2020

Wage index, Case Mix and Rural add-ons

Home Health Agency Billing

Ch. 10 Medicare Claims Processing Manual

Drugs and Biologicals Pub-100 Ch 17

Drugs and Biologicals Pub-100 Ch 17

Billing Requirements for OPPS

Billing Requirements for OPPS Providers with Multiple Service Locations

CMS PUB 100-04: Transmittal 4378

Home Health (HH) Patient-Driven Groupings Model (PDGM) - Revised and Additional Manual Instructions

Implementation

MLN Matters: MM11081

Home Health (HH) Patient-Driven Groupings Model (PDGM)

Revised and Additional Manual Instructions MLN MM11395

Medicare Benefit Policy Manual

Chapter 7 - Home Health Services

Home Health Medicare Billing Codes Sheet

CGS - Home Health Medicare Billing Codes Sheet

PDPM Fact Sheets

MLN PDPM Fact Sheets and Related Topics

NAHC

National Association for Home Care & Hospice

PDGM Education

Patient-Driven Grouping Model (PDGM) Education

Standard Written Order (SWO)

Dates of Service on or After January 1, 2020

Select the title to see a summary and a link to the full article.

New CPT® Codes Approved for COVID-19 Antibody Identification

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On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.

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CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

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Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...

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Who Qualifies for Chronic Care Management Services

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Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services." Examples of chronic conditions ...

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Preview the PDGM Calculator (HIPPS calculator) for Home Health Today

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Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator (HIPPS Calculator) simplifies payment calculations. See https://www.findacode.com/tools/home-health/ .

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New Medicare Home Health Care Payment Grouper — Are You Ready?

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In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.

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Medical ID Theft

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Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

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The OIG Work Plan: What Is It and Why Should I Care?

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The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

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The Facts of Critical Care

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Critical care services remain to not only be an area of confusion for providers, coders, and auditors, but also a constant target for the carriers for audit. We can sit back and look at critical care and think of all of the ways the code descriptor and/or use could be ...

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5 Ways to Minimize HIPAA Liabilities

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Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

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How to Properly Report Monitoring Patients Taking Blood-thinning Medications

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Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.

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Home Oxygen Therapy

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Home Oxygen Therapy Guidelines

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How to PREVENT and HEAL Dental Problems so You Can Enjoy a Healthy Body and Life

In this webinar Dr. Jorgensen will share with you the REAL causes of dental disease and techniques for prevention and healing. You will also learn about dental problems that may be making you or your patients SICK, how to identify them, and what can be done to help them get better. Finally, she will tell you about cutting edge dental and health practices you need to know about to improve your patient's health, and how to find a dentist that can provide this care. Don't miss this life-changing webinar!

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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How to Check NCCI Edits Using FindACode

How to Check NCCI Edits Using FindACode

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Home Health and Hospice Resources

  • ICD-10-CM Specialty Specific Code Book
  • Provider Documentation Guides
  • ICD-10-CM Comprehensive Code Books
  • and more...


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