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Friday, November 1, 2019

Home healthcare firms rally on final CMS rules for 2020

Home healthcare providers LHC Group (LHCG +13.2%), Amedisys (AMED +14.5%) and Encompass Health (EHC +7.1%) are solidly in the green after the U.S. Centers for Medicare & Medicaid Services (CMS) issued final payment and policy changes for calendar year (CY) 2020. Key points:
An alternate case-mix adjustment methodology called the Patient-Driven Groupings Model will be implemented featuring a 30-day unit of payment.
Home infusion drugs will be grouped into three payment categories, each paid in accordance with specified infusion codes. CMS is soliciting comments before full implementation in CY 2021.
Split-percentage payment amounts (currently 60% submitted in the first bill and 40% in the second bill based on a 60-day episode of care; 50/50 thereafter) will be reduced to 20% in 2020 and eliminated in 2021. Also in 2021, there will be no requirement for an upfront payment in response to a Request for Anticipated Payment (RAP), although they will still need to be submitted every 30 days. CMS believes these changes will reduce the administrative burden and mitigate fraud.
CMS is currently modifying current regulations to allow therapist assistants to perform maintenance therapy under the Medicare home health benefit aimed at consistency with skilled nursing facilities.

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