This is a very good question regarding PDGM, one I am also wondering about.

 

 

 

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

 

 

 

 

What software do you use Kori?

 

 

 

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

 

 

 

 

My understanding is that for now PDGM is only for FFS and I will dig for the reference on this.

 

 

 

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.

 

 

 

 

 

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

 

 

CONFIDENTIALITY NOTICE: This message (including any attachments) may contain confidential client information. The information is intended only for the use of the individual or entity to whom it is addressed. If you're not the addressee or the employee or agent responsible to deliver this e-mail to its intended recipient, you are hereby notified that any review, use, dissemination, distribution, disclosure, copying or taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately, delete this message from your computer and ask your network administrator to delete it from any storage or back up files.

***ALERT - External Email Sender***Always use caution when opening attachments or clicking links from external email senders.