Outsourcing Coding and Billing: Key to PDGM Success?

The upcoming Patient-Driven Groupings Model (PDGM), scheduled to take effect on January 1, 2020, will drastically alter the way home health organizations of all sizes manage operations. Among the several reasons is CMS’s decision to anticipate that providers will change behaviors in order to keep payments high and cut payments 6.42 percent in order to mitigate that assumed behavior. If providers do not change behaviors to boost payments, they stand to lose that 6.42%, or more than $1 billion across the industry, once PDGM takes effect.

Consequently, HHAs will find it increasingly more challenging next year to ensure they have the capital needed to fuel their missions to provide quality patient care. Billing demands will increase, reimbursements will change (not always for the better), and documentation will need to be a lot tighter. For those agencies who will be subject to the Review Choice Demonstration (RCD) — Illinois first, Texas and others later — a whole slew of other complications are possible.

To read the article in its entirety from “Home Care Tech Report,” click here.