Home Health Agencies Are not ‘Upcoding’ to Maximize PDGM Reimbursement

POSTED ON MONDAY, August 24, 2020

CMS, when creating PDGM, made assumptions on how home health agencies would act, but according to Homecare Homebase their assumptions were wrong.

“Among those assumptions, CMS believed home health agencies would automatically “upcode,” or pick the primary diagnosis code tied to the highest level of reimbursement. The agency likewise believed agencies would do everything possible to reduce their Low Utilization Payment Adjustment (LUPA) rates compared to years past.”

The data shows that this is not the case, clinicians are using the same codes they used to in close to 80% of all cases.

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