Home Health & Hospice Week

Episodes spanning Jan. 1 get 60-day rate.

You should be starting your ramp-up to the Patient-Driven Groupings Model already, experts agree. But just when do you need to plan to go live with the new model?

New guidelines the Centers for Medicare & Medicaid Services reviewed in its Feb. 12 MLN Matters educational call on PDGM will tell you. Sixty-day billing and payment applies for:

• episodes ending before Jan. 1, 2020; and
• 60-day episodes that begin on or before Dec. 31, 2019 and end on or after Jan. 1, 2020. In other words, episodes that would span the Jan. 1, 2020 PDGM implementation date.

Thirty-day billing and payment applies for:

• periods of care that begin on or after Jan. 1, 2020.

Remember: The 30-day period applies only to billing. “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,” CMS said.