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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What are the Most Common Family Practice CPT codes?

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The year 2020 began with many significant billing and coding updates for family physicians. A study found that Family physicians could not bill for all the services provided in the majority of their visits because CPT codes for medical billing did not cover the services, a study found.
Family practice medical billing services ensure that providers do not miss out on opportunities to maximize reimbursements. The correct CPT coding ensures a smooth medical billing process. The CPT coding system provides details about medical, surgical, and diagnostic services performed by healthcare professionals or physicians.
The coding system is developed and maintained by the American Medical Association (AMA), which offers healthcare providers “a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.”
The most common CPT codes used by family physicians for medical billing are 99213 and 99214. The CPT system and CMS Evaluation & Management (E&M) rule state that 99213 can be used if a physician treats a patient for one stable chronic condition, such as stable cirrhosis of the liver.

CPT Code 99213

The Current Procedural Terminology (CPT) code 99213 as maintained by the American Medical Association, is a medical procedural code under the range – Established Patient Office or Other Outpatient Services.
If you want to read the complete blog then click below:  What are the Most Common Family Practice CPT codes?
Location: United States

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