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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Everything You Need To Know About Podiatry Billing Services Guidelines

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Podiatry is one of the medical specialties, which concentrates on the diagnosis and treatment of the human feet and ankles. Podiatrists care about different conditions related to the foot such as heel spurs, toenails, fallen arches, foot/ankle injuries, and plantar fasciitis. Services offered by podiatrists should be paid for by either insurance companies or the patients or by both. Podiatry billing services are a very critical part of many practices.

As far as podiatry billing services are concerned, it is able to collect money efficiently from payers that are accountable for covering the services offered by podiatrists and patients. There are some services, which are not covered by payers, especially those which are not considered medically needed for appropriate foot care as per the Medicare Benefit Policy Manual (MBPM).

Below we Mentioned the Services which are Covered by Payers:

An exception to podiatry services covered

There are specific foot care services that are not covered by Medicare, and there are chances to be covered under general third-party insurance. If you avail of some sort of foot care services that fall into this category then it is a waste of time to hassle with your insurance company for reimbursement. Which are those services?

To know more about Podiatry Billing Services Guidelines click here: http://bit.ly/3Z5eHnU Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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