Patient Driven Grouping Models

The Centers for Medicare & Medicaid Services (CMS) announced a new home health payment reform plan effective January 1, 2020 that replaces a volume-based payment model with a value-based payment system.   

This model will focus on patient needs and rely more heavily on patient characteristics to pay for home health services.

• EXPANSIVE PHYSICIAN ORDERS
  Accommodate an unlimited number of secondary diagnosis codes, key for documenting comorbities.
• 30 DAY PAMENT EPISODES
  Careficient accommodates billing for 2 RAPs and 2 Final Claims per episode.
• LUPA THRESHOLDS
  LUPA logic changes in place, automatically calculate when patients fall under a LUPA based on HHRG and Clinical Groupings.
• REIMBURSEMENT
  Careficient accepts ERA from all MACs and easily posts them to patient invoices.
• OASIS SUBMISSION AND VALIDATION
  All necessary forms are fully integrated with the system and are automatically generated and sent to the state for you.
• PDGM ANALYZER
  Built in analyzer shows PDGM financial impact, projected reimbursements, and clinical groupings.
• OASIS SUBMISSION AND VALIDATION
  All necessary forms including OASIS – D updates are fully integrated with the system and are automatically generated and sent to the state for you.
• INTEGRATED ELIGIBILITY VERIFICATION
  Careficient verification fits seamlessly into your workflow process and automatically re-verifies for active patients.
• DASHBOARDS / WHITE BOARD
  Have all of your agency’s performance metric in key areas available fright from one screen, including Financials, Census, Discharge, and Associate reporting.