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Showing posts with the label Fix ASC Billing Margins

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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Fix ASC Billing Margins to Protect Surgical Revenue

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Fix ASC Billing Margins to Restore Financial Stability Ambulatory Surgery Centers (ASCs) are under increasing financial pressure. Rising supply costs, staffing challenges, payer reimbursement cuts, and complex billing rules are steadily shrinking profitability. When billing inefficiencies exist, even high surgical volume cannot protect ASC billing margins. Fixing ASC billing margins requires more than increasing case volume. It demands accurate coding, clean claims, payer compliance, and a disciplined revenue cycle strategy. Without these elements in place, revenue leakage becomes inevitable. Why ASC Billing Margins Are Declining ASC billing margins are declining across the U.S. healthcare system due to a combination of operational and reimbursement-related factors. Many of these issues remain hidden until cash flow is already impacted. Key contributors include: Underreported procedures and implants Incorrect CPT, HCPCS, and modifier usage Missed or delayed pre-authorizations ...
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Location: United States
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