Provider Contact Center (PCC) Frequently Asked Questions (FAQs): July 2019 - September 2019

Palmetto GBA is publishing the following Frequently Asked Questions (FAQs) based upon data analytics identifying topics generating a high volume of telephone inquiries between July 1, 2019, through September 30, 2019. We hope the answers to the questions below help you maximize your time by reducing your need to contact the Provider Contact Center (PCC). Home Health and Hospice Highest Inquiry Categories July 1 - September 30, 2019.

RTP/Status

7,655

Financial 1,991
Denial/Reject Explained

6,080

Appeals

592

General

4,158

Billing

1,959

FAQs Related to Highest Inquiry Categories for Home Health

Question: What is PDGM?

Answer: The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds.

Question: When does the PDGM begin?

Answer: The PDGM will take effect January 1, 2020.

Question: Will there be a change in episode payment intervals?

Answer: In conjunction with the implementation of the PDGM there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.
FAQs Related to Highest Inquiry Categories for Hospice

Question: Does it make a difference if the hospice general inpatient days that are necessary to qualify for a SNF stay occur in a hospital or a hospice inpatient care facility?

Answer: Yes, the stay must be in a qualified hospital or participating critical access hospital (CAH), in accordance with CFR 42 §409.30(a).

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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