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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How to Increase Revenue of Podiatry Practice after Implementing EMR?

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EMR implementation can be challenging, but if done correctly it can yield an increase in revenue. The initial investment then becomes affordable and the long-term results become quite compelling. Post-EMR implementation, an evaluation should be carried out to guarantee that the practice is functioning effectively to ensure staff and patient satisfaction. Some of the benefits of implementing EMR and how it can be leveraged to further increase revenue podiatry practice are discussed here.

1. Facilitates Growth in Govt. Claims Reimbursements

Government payers require meticulous documentation of all the routine checks of a patient, which is time-consuming. However, since Medicare requires documentation for everything billed, practitioners only bill for those items that have documented records. Due to this, doctors are deprived of about 15% of their reimbursements annually.

2. Reduces Malpractice Insurance Premiums

Improved documentation, audit trails, and accuracy helps reduce medical billing errors, and may also increase the chances of physicians receiving discounts from insurers. An EMR system reduces costs related to poor documentation which could have resulted in higher malpractice premiums.

3. EMR can Maximize Revenue

Physicians can increase their revenue if they code appropriately and do not own code. Some software programs recommend coding based on the service documented in the EMR. Medical Economics magazine has estimated that doctors who frequently down code to avoid audits, lose an average of $40,000 per year.

4. Health Maintenance Reminders

EMR systems set reminders for overdue appointments. This enables physicians to remind their valued patients of timely check-ups and extend quality patient care. It also boosts their service volume and revenue in turn.

5. EMR Decreases Admin Costs

Switching to EMR minimizes storage space, allowing a possibility for another consultation room. Office supply expenses such as purchasing, copying, storing, or destroying paper charts are also eliminated. EMR software comes with prebuilt templates that let you document patient complaints quickly.

EMR eliminates transcription costs, thereby eliminating hiring or paying transcribers and medical records clerks. Instead of cutting labor costs, a better alternative would be to hire an assistant who will help you cater to more patients and increase your practice’s efficiency.

To learn more about How to Increase the Revenue of Podiatry Practice after Implementing EMR?, click here: https://bit.ly/44C5d5Z Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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