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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Choosing the Right Internal Medicine Billing Solution

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According to a Physician Compensation survey conducted by Sullivan, Cotter, and Associates, specialty physicians across the US saw a 1.9% increase in their compensation in 2014. Internal medicine physicians also experienced a two percent change in their compensation between 2013 and 2014. The median total cash compensation for them recorded in 2014 is $213,428.

Even though the internal medicine specialty witnessed a slight increase in compensation this year, many internists continue to grapple with a shrinking bottom line. This is because treatment by an internal medicine physician depends on or collaborates with different diagnostic laboratories and care to justify. Due to such varied aspects in the treatment episode, the medical billing and coding become complicated. The medical claims for internists require joint coding of services. They also have to deal with a variety of separate codes as they have to treat various health disorders.

Did you know that internists have the fifth-highest burnout rate among physicians? On average, they see 20 – 30 patients a day, working for long hours every week. The pressure caused by healthcare reforms has heightened their workload. 

For More Information Regarding Internal Medicine Billing Solution Click Here: Choosing the Right Internal Medicine Billing Solution

Location: Ohio, USA

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