For those of you in border communities, Security Health in Wisconsin is adopting PDGM.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mary Jonason
Sent: Wednesday, November 13, 2019 11:39 AM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: RE: PDGM HMOSalin, Tracy <tsalin1@range.fairview.org>
We have heard Humana may also be going that direction but nothing in print yet.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jennifer Larsen
Sent: Wednesday, November 13, 2019 11:36 AM
To: billers@list.mnhomecare.org
Subject: RE: PDGM HMOSalin, Tracy <tsalin1@range.fairview.org>
Thank you for sharing! I have questioned every Insurance company and BCBS and UHC were the only 2 who stated they will need the PDGH HIPPS code. Does anyone else know anything different?
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 Salin, Tracy
Sent: Wednesday, November 13, 2019 11:15 AM
To: billers@list.mnhomecare.org
Subject: PDGM HMOSalin, Tracy <tsalin1@range.fairview.org>
From a BCBS Bulletin 11/1/19
CONTRACT UPDATES
CMS Changing Payment Classification System for Home Health Effective January 1, 2020
(P76-19, published 11/1/19)
Effective January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) is transitioning to the Patient Driven Groupings Model (PDGM). PDGM is a new payment model for
Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds.
In accordance with Article XIII, B. of the Amendment to the Agreement - Medicare Programs, Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross), effective January 1, 2020 will also begin utilizing the PDGM payment rate classification system to
determine reimbursement for Medicare Health Services (for SecureBlue (MSHO) and Medicare Advantage products) provided and billed by a Home Health Agency for those services that qualify.
Page
3 of 13
Transition Scenarios
• For 60-day episodes that begin on or before December 31, 2019 and end on or after January 1, 2020 (i.e., episodes that span the January 1, 2020 PDGM implementation date),
payment will be the calendar year (CY) 2020 national, standardized 60-day episode payment amount
• For HH periods of care that begin on or after January 1, 2020, the unit of payment will be the calendar year (CY) 2020 national, standardized 30-day payment amount
• Under the PDGM, recertification for home health services, updates to the comprehensive assessment and updates to the HH plan of care will continue on a 60-day basis
Providers should submit the PDGM for Health Services using the Health Insurance Prospective Payment System (HIPPS) code that is generated from assessments with an Assessment
Reference Date (ARD) on or after January 1, 2020. Blue Cross will publish additional information to assist providers as more details become available.
Products Impacted
This change only applies to:
• SecureBlue (MSHO)
• Medicare Advantage
• Platinum Blue
Questions?
If you have questions for a member enrolled in a Minnesota Health Care Programs (MHCP) plan, please contact provider services at
1-866-518-8448. Please contact provider services at (651) 662-5200
or 1-800-262-0820 for all other questions.
Tracy Salin
Billing Specialist
Fairview Range Home Care and Hospice
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.