Home Health Agencies: Here's Why PDGM Payments Keep Falling Short

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Home health agencies can provide the right care, submit claims on time, and still see Medicare reimbursement come in lower than expected. The reason is often not simply a billing error. Under the Patient-Driven Groupings Model (PDGM), reimbursement depends on several factors, including the patient's clinical characteristics, functional needs, comorbidities, timing of the period, and whether the period meets the requirements for a full 30-day payment. For 2026, CMS also finalized changes to PDGM case-mix weights, functional impairment levels, comorbidity adjustment subgroups, and Low-Utilization Payment Adjustment (LUPA) thresholds. CMS also finalized permanent and temporary payment adjustments for home health. That means a reimbursement drop deserves more than a quick review of the claim amount. The real question is: What changed between the care provided and the payment received? How PDGM Determines Home Health Payment PDGM uses a 30-day period of care rather than the older 60-day...
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Benefits of Outsourcing DME Billing to Improve Your Revenue

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As any durable medical equipment (DME) provider will confess, securing reimbursements from Medicare and private insurance carriers is one of the biggest challenges of running a DME business. It’s time-consuming and labor-intensive, and for all their effort, DME providers don’t always get full reimbursements. If not paid attention, inaccurate DME billing could lead to lower revenues and, in worst-case scenarios, cause DMEs to windup their business. Outsourcing your DME billing services to reliable medical billing companies like MedicalBillersandCoders (MBC) could be a smart and efficient way to get maximum reimbursements and countless other benefits. Some of the Benefits of Outsourcing DME Billing services are listed below. 

Benefits of Outsourcing DME Billing to Improve Your Revenue

Less Billing Errors

DME billing offers a unique set of challenges. It includes coordinating with different parties and requires an understanding of the HCPCS (Healthcare Common Procedure Common System) Level II codes. Each type of DME has a unique HCPCS Level II code, and the biller is responsible for ensuring that each piece of equipment is coded correctly. For example, when submitting a claim for a continuous positive airway pressure (CPAP) machine, the biller needs to code the machine as well as the mask and tubing used with it individually.


If you want to read the complete blog then click below: Benefits of Outsourcing DME Billing to Improve Your Revenue


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