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?

Code Sets

CPT Codes

CPT Procedure Codes

ICD-10-CM Codes

ICD-10-CM Diagnosis Codes

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

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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.

PDPM Grouper 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 ...

How to Properly Assign ICD-10-CM Codes for Pain

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Pain is a common diagnosis among all specialties so it should not be surprising to find there are 162 ICD-10-CM codes for reporting it and over 80 mentions in the ICD-10-CM Official Guidelines for Coding and Reporting which describe when certain types of pain should be reported and how the codes should be sequenced.

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

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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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