It goes by contracts with ucare. We are not contracted to bill PDGM.

Tracy Salin

Billing Specialist

Fairview Range Home Care and Hospice

Phone: 218-262-6982

Fax: 218-262-1723

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Tuma, Darlene
Sent: Wednesday, August 19, 2020 4:41 PM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: RE: PDGM vs non-PDGM

This is what I got from UCARE but this is a person on UCARE MSHO.

UCARE MSHO will be different that a UCARE Advantage (non MA) Medicare. The inconsistency is very frustrating. Makes for a billing nightmare.

Hi Darlene,

I just confirmed with our payment policy staff – we are currently not pricing under the Home Health episodic payment and are pricing at the per visit payment.

Does that help clarify?

Thanks,

Annie Halland, MPH | County Manager, Government Relations

612-676-3317

From: Tuma, Darlene <dtuma@co.le-sueur.mn.us>
Sent: Wednesday, August 19, 2020 10:17 AM
To: Annie Halland <ahalland@ucare.org>
Subject: [EXTERNAL]RE: home care therapy rates

Darlene Tuma, RN, PHN

Adult Health Supervisor

Le Sueur County Public Health

88 South Park Ave

Le Center, MN 56057

507-357-8249

Fax: 507-357-4223

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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Kori Meyer
Sent: Wednesday, August 19, 2020 10:09 AM
To: billers@list.mnhomecare.org
Subject: RE: PDGM vs non-PDGM

I’m thinking there’s a lot of mixed messages from insurance companies, and guidelines/reimbursement are probably influenced by who you have direct contracts with. We pretty much do the opposite of Marnie – for example, we bill RAP and Final for BCBS Medicare and BCBS MSHO (Medicare) and get paid according to CMS rates. For Humana, United Health Care Medicare Advantage, and UCare Medicare we bill PDGM coding on a Final claim only that is per calendar month, not per 30d period, and get paid our contracted per visit rate (not CMS rates). So confusing – I wish there was a one-size-fits-all answer, but it doesn’t seem that way – at least not yet. Maybe things will improve??

Kori

Pathways to Achievement

Duluth MN 55806

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Marnie Pogreba
Sent: Wednesday, August 19, 2020 9:29 AM
To: billers@list.mnhomecare.org
Subject: RE: PDGM vs non-PDGM

These are the pay sources that I bill using PDGM.

Humana

BCBS Medicare Advantage – (does not require a RAP just a Final).

BCBS MSHO (Medicare) – (does not require a RAP just a Final)

Tri Care

United Health Care Medicare Advantage

Marnie

Lakewood Health System

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Tuma, Darlene
Sent: Wednesday, August 19, 2020 9:14 AM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: PDGM vs non-PDGM

**External Sender**

Does anyone have a listing of which health plans are PDGM and which are not?

There may also be a difference between if they are a medicare advantage plan or someone on MSHO. I can’t get a straight answer from some of the health plans; I don’t know if they know what they are.

Thanks

Darlene Tuma, RN, PHN

Adult Health Supervisor

Le Sueur County Public Health

88 South Park Ave

Le Center, MN 56057

507-357-8249

Fax: 507-357-4223

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