We use NetSmart. They published a notice this week asking providers to check with their Med Adv payers, and to let NetSmart know if any of them are not going to adopt PDGM so they could review
them on a case-by-case basis.
Kori Meyer
Biller | Pathways to Achievement, Inc
114 S 20th Ave W Suite A | Duluth MN 55806
218.623.7106 | Fax 218.491.7185
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jennifer Larsen
Sent: Thursday, September 19, 2019 12:36 PM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM
What software do you use Kori?
Be Compassionate. Be Accountable. Be Respectful. Be Excellent!
Jennifer Larsen
Claims Specialist
Guardian Angels Elim Home Care and Hospice
403 Main Street, Elk River, MN 55330
Main 763-241-0654
Direct 763-452-4101
Email
jlarsen@gaehc.org
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Kori Meyer
Sent: Thursday, September 19, 2019 10:38 AM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM
That is my understanding as well. I believe it was the CMS Provider Call on 8/21 that reiterated that it was up to the discretion of the Med Adv payer whether or not they adopt PDGM.
Our issue is if Med Adv payers do
not adopt PDGM, how will we generate a PPS HIPPS code after 1/1/20 with OASIS D1 assessments that only generate
PDGM HIPPS codes?
I’m crossing my fingers that the Med Adv plans will adopt PDGM, but I’m not seeing anything from anyone anywhere about it and its making me nervous!
Kori Meyer
Biller | Pathways to Achievement, Inc
114 S 20th Ave W Suite A | Duluth MN 55806
218.623.7106 | Fax 218.491.7185
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jane Vujovich
Sent: Thursday, September 19, 2019 10:22 AM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM
My understanding is that for now PDGM is only for FFS and I will dig for the reference on this.
Jane Vujovich
| Regional Director - South
Office:
651-388-1010 | Fax:
651-388-1178 | Cell: 612-616-7935
120 Hedin Avenue, Suite 101
Red Wing, MN 55066
Hopkins Office:
952-935-3515
1011 1st Street South, Suite 315, Hopkins, MN 55343
Email:
janevujovich@accracare.org | Website:
www.accracare.org
Alexandria | Bemidji | Brainerd | Duluth | Fergus Falls | Grand Rapids | Hopkins | Lake City | Moorhead | New Ulm | Red Wing
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From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Karen Peterson
Sent: Thursday, September 19, 2019 10:05 AM
To: billers@list.mnhomecare.org
Subject: RE: Medicare Advantage payers and PDGM
This is a really good question and I hope several of you are able to chime in with your experiences. This was brought up at the recent Home Care Policy Summit
I attended a couple of weeks ago – they didn’t have any answers to share, just that we should each, in our respective states, learn what will happen with our Medicare Advantage Plans.
Your responses to Kori’s question will help me figure out how to proceed!!
Thanks in advance –
Karen Peterson
Regulatory Affairs and Advocacy Manager
Minnesota HomeCare Association
2550 University Ave. W., Ste. 350 S | St. Paul, MN 55114-1900
Direct: 651.659.1457 | Main: 651.635.0607
Toll-free: 866.607.0607 | Fax: 651.635.0043
www.mnhomecare.org
| kpeterson@mnhomecare.org
Mission:
MHCA represents and supports Minnesota home care providers committed to high quality home care services.
Vision:
MHCA will shape the home care landscape to improve and sustain quality home care services.
From:
billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Kori Meyer
Sent: Thursday, September 19, 2019 9:46 AM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: Medicare Advantage payers and PDGM
Has anyone seen anything from any of the Medicare Advantage payers regarding a decision to adopt PDGM? Or not adopt?
Our software is not going to support PPS HIPPS code OASIS D assessments once OASIS D1 PDGM HIPPS codes are implemented unless we can point to specific payers that will still require PPS HIPPS
codes after 010120. I have not had any luck contacting individual payers (BCBS MSHO, Humana, Aetna, UnitedHealthcare), and am wondering if anyone else has had better luck and gotten some specific answers?
Thanks in advance!
Kori Meyer
Biller | Pathways to Achievement, Inc
114 S 20th Ave W Suite A | Duluth MN 55806
218.623.7106 | Fax 218.491.7185
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