Medicare Reimbursement – Home Health Prospective Payment System (PPS) Patient Driven Groupings Model
On January 1, 2020 the new Patient Driven Groupings Model (PDGM) was implemented by the Center for Medicare and Medicaid Services (CMS). CMS is modernizing the Home Health Prospective Payment System (PPS) case-mix classification system and promoting patient-driven care.
Molina will reimburse home health services according to the CMS Medicare methodology for the PDGM implementation with an exception for Request for Anticipated Payment (RAP) processing. With Medicare implementing a change in the unit of payment from 60 days to 30 days as required by the BBA of 2018, Molina will no longer be paying on RAP claims. Payment will be made for each 30-day period of care on the final claim. The submission of a RAP claim will be processed as a “no pay” RAP. A Frequently Asked Questions (FAQ) resource document can be located at PDGM FAQs which will address Molina’s transition plan and the RAP exception process.
Click here to read the full announcement sent out by Molina.