Just got this today. Highlighting and underlining are Aaron’s.

Hi Kori,

Please see the information below regarding UHC and PPS or PDGM as of January 1, 2020.

UnitedHealthcare will recognize the upcoming 1/1/2020 CMS modification to the Home Health Prospective Payment System (HH PPS) from “HHRG” (Home Health Resource Groups) to “PDGM” (Patient-Driven Groupings Model) for non-participating Home Health care providers.

However, for participating providers contracted under the standard M&R Home Health payment appendix with negotiated, fixed rates, those payment appendices will not automatically implement the new PDGM reimbursement methodology.

Home Health providers, whether or not they are contracted under the Home Health PPS methodology, are required to submit claims with Revenue Code 0023 and applicable HIPPS (Health Insurance Prospective Payment System) codes. As the Home Health payment appendix only requires “applicable HIPPS codes” and doesn’t specify “HHRGs”, the appropriate HIPPS code as of 1/1/2020 will be those specific to PDGM.

Thank you,

Aaron

Aaron Thomson

UnitedHealth Networks

Provider Relations Advocate

MN, ND, & SD

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Salin, Tracy M
Sent: Monday, December 23, 2019 8:31 AM
To: billers@list.mnhomecare.org
Subject: RE: pdgm

They have not confirmed. I believe they will.

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Patti Fladwood
Sent: Monday, December 23, 2019 8:28 AM
To: billers@list.mnhomecare.org
Subject: pdgm

Does anyone know if United Healthcare is going to PDGM??

Patti Fladwood

BILLING SUPERVISOR

Optage Homecare, Hospice, and Primary Care

Presbyterian Homes & Services

2845 Hamline Avenue North, Roseville, MN 55113

Tel:(651)631-6198; Email: pfladwood@preshomes.org

Optage^® is the home and community services division of Presbyterian Homes & Services.

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