Eli's Home Care Week

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2019 Prospective Payment System: Medicare's New Pay Reform Proposal

If you didn’t like Medicare’s ideas on home health payment reform last year, you’re probably not going to be happy with its newly proposed model either. The Patient-Driven Groupings Model unveiled in the 2019 Home Health Prospective Payment System proposed rule is largely the same as last year’s Home Health Groupings Model, with only one major difference — the price tag.

As required in the Bipartisan Budget Act of 2018 enacted earlier this year, CMS has proposed the new PDGM payment reform model as budget neutral.

Once the PDGM takes effect in January 2020, agencies will see reimbursement for their episodes determined by four steps:

Step 1: Classify episodes into four categories based on timing and source of admission — Community Early, Community Late, Institutional Early, Institutional Late.

Step 2: Slot episodes into six clinical groupings based on principal diagnoses reported on the claim

Step 3: Assign episodes as Low, Medium or High functional levels based on OASIS responses

Step 4: Adjust for comorbidities based on secondary diagnoses

If your agency’s finding it difficult to keep up with ever-changing Medicare home health rules and regulations, then it is time to equip yourself with a best-in-class resource that will keep you informed, guide you through new requirements, and show you how to mitigate adverse effects of Medicare’s impending payment reform.

Eli’s Home Care Week covers all your bases, delivering news and analysis on topics ranging from reimbursement, OASIS, IMPACT Act, fraud and abuse, medical review, documentation, regulations, and more.

Editor Rebecca Johnson brings 20 years of experience in home care to the table, so you can rest assured she’s got your back in 2018. And 45 weekly issues in your annual subscription means you don’t have to waste valuable time searching elsewhere to keep pace with the industry and find answers to conquer your biggest challenges and day-to-day reimbursement and regulatory activities.

Profit from solutions to problematic issues and insights on critical updates with articles such as:

  • 2.1% Pay Hike To Bring $400M More To HHAs Next Year
  • Medicare's New Pay Reform Proposal Looks Awfully Familiar
  • These 8 OASIS Items Will Determine Your Functional Scores Under PGDM
  • Check Out The Secondary Dx Groups That Will Boost PDGM Pay
  • Medicare Wants To Scrap RAPs Under Payment Reform
  • Proposed Rule Cites Abuses In Pushing For RAP Elimination
  • Medicare Provides More Info On Pay Reform This Time Around
  • Proposed Rule Snuffs Out Any Hope For Documentation Reform Based On BBA 18
  • OIG Targets LUPA Gaming In Newest Work Plan Item

Get updates on:

  • Value Based Purchasing – more revisions that impact agencies
  • Pre-payment review: How to prepare for it
  • OIG’s latest home health report
  • Face-to-face documentation tips
  • Therapy-based denials: how to avoid them


As an active subscriber, you’ll also receive access to some of the richest online resources for home care agencies, including a keyword-searchable database of your newsletter content on SuperCoder.com. This allows you to look up and review more than 900 archived issues of Eli’s Home Care Week, a $249 value.

We’re so confident that your subscription will pay for itself countless times over that we stand behind it with our 100% Money-Back Satisfaction Guarantee.

Start receiving vital insights on regulations and reform, as well as advice to overcome the spectrum of issues threatening your bottom line. Order online or call (800) 508-2582 to begin your subscription.
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