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We help you keep track of evolving payment policies for home health.

Medicare payment for home health physical therapy services is under a prospective payment system, meaning there’s a predetermined base payment according to a classification system of services — in the case of home health, the Patient-Driven Groupings Model.

Home health services also are subject to quality reporting requirements using OASIS — the Outcome and Assessment Information Set.

See more information on home health physical therapy.


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APTA Suggests: More on the Review Choice Demonstration

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Patient-Driven Groupings Model

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The PDGM is a shift away from volume-driven home health payment to a model that focuses on the unique characteristics, needs, and goals of each patient.

CMS Resources on Payment in the Home Health Setting

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APTA Home Health Section

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Additional Medicare Payment for Home Health Content

Quick Guide to Using the PTA Modifier

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Use this guide to help you identify when you must apply the CQ modifier. When billing timed treatment codes, first determine the total number of units that can be billed based on the 8-minute rule. Then determine, for each unit, whether the PTA furnished more than 10% of each unit independent of the physical therapist.

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CMS recommends significant payment reductions to more than three dozen health care provider groups for in the 2021 Medicare Physician Fee Schedule Proposed Rule.

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A bipartisan bill in the House would allow CMS to avoid damaging cuts in 2021 and establish permanent telehealth for therapy providers.

Win: Telehealth Outpatient Therapy

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The clarification from CMS applies to settings that use institutional claims such as UB-04.

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Since January 2017, PTs use three evaluation codes and one reevaluation code.

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Here's information on how to apply the new CQ modifier to denote when outpatient therapy services are furnished in whole or in part by a PTA.

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