Hi Karen, regarding UHC, our contract rep did confirm that they will need the HIPPS code on these claims.  Anyone else receive an answer from UHC?  I plan on grilling our contract reps again at the end of this month.

 

 

 

I have also been trying to reach out to Medicare Advantage plans to ask about PDGM; what I have heard is consistent with what you all are reporting:

 

Not planning on accommodating PDGM changes:

• Medica
• Senior Preferred
• UCare (though left open door of “possible change in the future”)
• United Healthcare

 

Planning to accommodate PDGM changes:

• Humana
• Itasca Medical

 

No response:

• Aetna
• BCBS (though Tracy’s email earlier says they WILL accommodate)
• HealthPartners
• Prime West
• South Country Health Alliance

 

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.

 

 

 

 

 

 

Yes, thank you Tracy.  I am very grateful for this wonderful group. J

 

I called South Country Health Alliance, and for those of you who will be in the counties still accepting SCHA, they will be using the PDGM model.

 

Our contact at Medica said there would be no changes with Medica.  Curious if anyone has heard differently on Medica.

 

UCare said that based on our contract, since we do not bill episodically with UCare, they are not changing either for us.

 

Marnie

 

 

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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?

 

 

 

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

 

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