2020 has been an interesting year for all of us. 

I wanted to share with all of you what I learned so far today at the Medicare Training Administrators Conference. 

This is an owners/executive event that occurs once a year for owners to learn about the new updates from Medicare. I was lucky enough to sit with the expert, my friend Jim Plonsey, from Medicare Training and Consulting. I figured I would share some of the highlights of our conversation this morning over breakfast.

Baby Boomers will fuel increased demand starting in 2021. The long view “Silver Tsunami” will not have a full effect for a few years still. The number of home health providers peaked in 2013 at a total number of 12,459. 

In 2019, we lost a total of 490 providers and at the end of 2019 we had 10,612 Medicare-certified home health agencies. Texas followed by California have the most providers.

Medicare Advantage plans are continuing to dominate in gaining market share.

Medicare Advantage participation is predicted to hit 50% by the end of 2020 and grow 9% over next 10 years.

Hospice organizations continue to open around the country. In 2019 there were a total of 4970. 

Level of care billing showed some changes for hospices:

  • Routine Home Care was billed 89%
  • GIP up to 6.44%
  • Inpatient Respite Care 1.95%
  • Continuous Home Care 1.79%

Hospice will receive a 2.4% net reimbursement increase. Home health will have no increase. Aggregate hospice Cap is projected at $30,743.96 for 2021.   

The Office of the Inspector General (OIG), a division of the Department of Health and Human Services, has released a memo detailing the surge of Americans relying on hospice care in the 10-year period from 2006-2016.

Some of the most notable findings include:

  • The number of hospice providers has grown 43% (from 3,062 in 2006 to 4,374 in 2016)
  • Medicare spending on hospice is up 81% (from $9.2 billion in 2006 to $16.7 billion in 2016)
  • The number of those who received hospice care increased by 53%
  • The number of Medicare beneficiaries who received hospice care rose 32%

The surge in those relying on hospice has led government officials to take a closer look at the quality of care provided to those receiving hospice services within their own home, in an assisted living facility, nursing home, or inpatient hospice facility.

The OIG’s report publicly voices concern about the care that is given vs. the care that is promised, as well as the level of treatment being billed to Medicare. The report references The Centers for Medicare and Medicaid Services’ (CMS) citations against hospice providers and legal cases, including failure to follow simple pain management standards. This is an especially frustrating revelation given that the primary goal of hospice is to provide respite from physical and emotional pain during one’s final days.

Target Areas:

  • Live discharge
  • Long LOS
  • Facility patients
  • GIP services
  • Diagnosis and coding of claims

Home health did not receive any rates increase for 2021.  In addition, home health will have their RAP’s moved from 20% to 0%.

FINAL 2021 PDGM Base Rates

30 Day Payment Unit $1,864.03

Payment Update CY 2020 x 2.0%

Standardized Payment Rate = $1,901.12*

Sequestration Reduction (-2.0)

Final Payment Rate $1,863.84

Telehealth guidelines

Telehealth can be used for all patients to meet the requirements of the F2F visit.  This visit may be conducted & billed by any allowed practitioner: MD, DO, APN, PA, Podiatrist, or nurse midwife.

  • Two-way audio and visual must be present.
  • Home care agencies can educate/coordinate/facilitate the visit for the F2F or other visits needed by the patient’s care team.
  • The visit can occur during a skilled visit, but facilitation alone is not a billable service.

Telehealth is here to stay. It took the pandemic to get this to the patients who needed it most. 

We also talked about using all the money the agencies received from PPP, Cares act,  money you received in order for it not to be a loan, needs to be spent and you can spend it on consulting.  Hint (Wink, wink). I will continue to learn throughout the day and will share more in my next blog post.   

Cheryl Peltekis, RN “The Solutionist”


Want to uncover how you can finish 2020 strong and have the best 2021 you’ve ever had? Go check out www.homecaresales.com and learn more or email Mike@homecaresales to see a demo.

You can also claim some of Mike’s time directly on his calendar here: