Home Health|Hospice Articles and Resources

News and Important 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?

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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

Ch. 4 Claims and Attachments Menu

Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Guide

CDE's

CMS- Clinical Data Elements

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

58% of Improper Payments due to Medical Necessity for Ventilators

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Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

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Incident To

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Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...

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New Codes for Cytokine Release Syndrome (CRS)

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New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.

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New Value-Based Payment Models for Primary Care (Primary Care First and Direct Contracting)

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This article summarizes the new Medicare value-based payment models: Primary Care First and Direct Contracting.

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Modifier 50 — Four "Must Know" Tips For Getting Paid

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Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

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New Grouper Added for Skilled Nursing

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The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay. This grouper is included with our Home Health Grouper.  Current groupers/calculators include: Home Health PDGM (Patient-Driven Grouping Model) Skilled Nursing Facility PDPM (Patient-Driven Payment Model) What is it? According to CMS, In ...

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Are NCCI Edits and Modifiers Just for Medicare?

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The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

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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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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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Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?

Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success). Some of the resources and tools they discuss will help you with your dental coding/billing and education.

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