Below the Affected person-Pushed Groupings Mannequin (PDGM), 80% of dwelling well being companies are experiencing a distinction in reimbursement in comparison with the outdated Potential Fee System (PPS). Of these, the overwhelming majority — 82% — are experiencing a lower in reimbursement.
That’s in keeping with a latest survey of 127 dwelling well being companies carried out by info know-how agency Skill, an Inovalon firm.
Though a good portion of suppliers stated their reimbursement charges have gone down within the early days of PDGM, 54% of surveyed companies stated the lower was merely “reasonable.” David Swenson, a gross sales engineer on the Skill, mentioned the findings Tuesday throughout a webinar hosted by HHCN.
Aside from the survey outcomes, the transition to PDGM seems to be going easily total, no less than in comparison with the sometimes rocky highway that expert nursing operators confronted with their very own Medicare reimbursement overhaul.
Medicare Administrative Contractors (MACs) are processing claims well timed and with little disruption. Moreover, PDGM’s cash-flow projections have largely performed out as anticipated, in keeping with Brian Harris, consulting director at BlackTree Healthcare Consulting.
“There’s actually a variety of constructive information right here,” Harris stated, additionally talking throughout Tuesday’s webinar. “In a variety of the lead-up to PDGM, there have been considerations about how Medicare was going to adapt to the change, how their techniques had been going to course of claims. And throughout all MACs all through the nation, we’re actually seeing them working beneath the usual pre-PDGM claims processing timelines.”
That isn’t all the time true, as Harris famous there have been hiccups right here and there, reminiscent of a small quantity of claims being held up in handbook processing for as much as 30 days. However typically, trade outlook is constructive by means of PDGM’s first 60 days.
“For probably the most half, we’re seeing these last claims are available in and pay at that 10 to 14 [day] timeline, with RAPS (Requests for Anticipated Fee) in that seven- to 10-day timeline,” Harris stated. “And usually claims appear to be paying on the reimbursement charges which are anticipated.”
In style Studies
House well being suppliers additionally appear to be discovering success in minimizing PDGM’s Questionable Encounter (QE) threat. Broadly, QEs are main analysis codes which are now not reimbursable beneath PDGM.
After the primary week of 2020, trade analyses confirmed that 6% of dwelling well being intervals had been nonetheless beneath QE standing. Whereas low, that was a stunning share contemplating all the academic efforts that came about in 2019, Harris stated.
“That’s positively an enchancment [over what] CMS estimated, however being that this was an enormous subject of dialog going into PDGM and a giant space of concern, we anticipated suppliers to be leveraging their EMRs … to essentially get out forward of [this].”
Since Feb. 18, nonetheless, that QE share has decreased to 0.5%, suggesting dwelling well being suppliers are adapting shortly.
Along with the beforehand talked about findings, the Skill survey of 127 dwelling well being suppliers additionally discovered that 84% of companies are submitting extra claims per thirty days. Particularly, mid-sized companies have reported submitting a median of 110 claims per thirty days.
As an increasing number of knowledge is out there from the primary yr of PDGM, each good and dangerous traits will develop into extra obvious. For instance, it’s nonetheless too early to inform if the overhaul has triggered an over-correction to remedy utilization or a drastic shift away from group referrals.