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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Reducing the Impact of Internal Medicine Revenue Challenges

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Many internists are opting out of private practice due to rising costs and reduced reimbursements. Billing and administrative challenges are also adding to their woes, forcing them to join large medical groups or take up jobs in hospitals. They are quitting their private practice to avoid the revenue challenges and the hassles of running a medical office.

According to industry surveys, it has been observed that more than 70% doctors are spending one full day in a week on paperwork. For instance, a Physicians Foundation survey states that approximately 44% doctors are looking for ways to reduce their work hours and patients. Estimations have been made by the industry experts that productivity of physicians is estimated to drop by 25% due to mounting administrative burden. Similar to other specialties, many internists and their staff are also struggling with financial and administrative issues that pile up throughout the day or the month.

Looking for more information about Internal Medicine Revenue Challenges click here: https://bit.ly/3xHObFg. also you can get in touch with us at info@medicalbillersandcoders.com or call us at 888-357-3226.

Location: California, USA

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