Skip to main content

Major changes are coming to the case-mix methodology and payment system for home health agencies (HHAs) under Medicare. What are the key details? How will physical therapists (PTs) and physical therapist assistants (PTAs) be affected?

Let's look at what PTs and PTAs need to know about the Home Health Patient-Driven Groupings Model (PDGM) to ensure that patients in home health get optimal access to the physical therapy services they need.

Background

Current Medicare payment for home health services under the Prospective Payment System (PPS) is based on a 60-day episode of care. (If fewer than 5 visits are delivered within a 60-day period, payment is based on a standardized per-visit payment by discipline rather than by payment for a 60-day episode. This is called low-utilization payment adjustment, or LUPA.)

Log in or create a free account to keep reading.


Join APTA to get unlimited access to content.

  1. Bell A. Understanding the CPT process. PT in Motion. 2018;10(10):8-11.
  2. AMA CPT® 2018 Professional Edition. Chicago, IL: American Medical Association; 2017.

You Might Also Like...

Column

Your Questions Answered

Dec 1, 2019

Use the information and resources here to get the details you need on regulatory compliance and related legal issues.

Column

Advocating for the Profession in the Evolving Payment Environment

Aug 1, 2019

APTA and its chapters offer a variety of member resources to promote advocacy for appropriate payment of physical therapist services.

Column

Responding to Targeted Medical Review

Jul 1, 2017

CMS is reviewing some therapy claims that exceed the $3,700 Medicare Part B threshold. Here's what to know, and what to do, if you are contacted