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 Constitutes Behavioral Health Billing Services?

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You might be already aware of how behavioral health billing is different from medical billing, you’ll wonder what falls under billing for behavioral health services with reference to the services we offer at Medical Billers and Coders and the kinds of behavioral health billing we will assist with include:

Behavioral Health Billing

To successfully bill for behavioral health, you would like a good understanding of the varied codes that behavioral health treatments fall into. Billing errors can reduce your collection as well as lead to rejections and cause delays in payment. We’ll ensure your behavioral health billing claims are submitted correctly and on time.

Psychologist/Psychotherapy Billing

If you use billing software that does not properly consider psychology creates challenges in billing which can lead to a loss in the collection. Finding the correct codes and keeping track of reimbursed claims are often difficult. 

For More Information Regarding Behavioral Health Billing Solutions Click Here: What Constitutes Behavioral Health Billing Services?


Location: California, USA

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