Posts

Showing posts with the label Home Health Billing Errors

Home Health Agencies: Here's Why PDGM Payments Keep Falling Short

-
Image
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...
Post a Comment
Read more

What Hidden Home Health Billing Errors Could Be Costing You?

-
Image
Hidden Home Health Billing Errors, especially Low Utilization Payment Adjustment (LUPA) errors, can silently erode margins, delay reimbursement, and restrict net realized revenue growth.  Many agencies assume their billing process is stable until declining financial performance metrics reveal deeper structural problems. In today’s PDGM-driven environment, minor documentation gaps or coding missteps can significantly impact EBITDA. The issue is not just claim submission—it is precision, payer alignment, and operational control. The Most Costly Hidden Home Health Billing Errors 1. Low Utilization Payment Adjustment (LUPA) Errors LUPA errors occur when visit thresholds are miscalculated or poorly monitored. Dropping below the required visit count can reduce reimbursement dramatically. Without real-time tracking and payer variance detection, agencies often recognize the issue only after payment posting. 2. Incorrect PDGM Diagnosis Selection Improper primary diagnosis coding changes cas...
Post a Comment
Location: United States
Read more