Did you know that the Centers for Medicare & Medicaid Services (CMS) has shared some important updates on how Medicare will pay for home health services in 2025 and they have just released this big update on 1st November this year? These updates are all about informing you how your home health practice would be paid along with the payment rules for the intravenous immune globulin (IVIG) suppliers. Now, the excellent news for you is that the Medicare payment for the home health billing service is expected to go up by 0.5% in 2025. It almost accounts for $85 million compared to this year (2024). This new update would allow you to ensure that your patients get improved care at their homes! 

The new rule makes a small cut of -1.975% to the 2025 payment rates for home health services. This change helps adjust how Medicare pays, based on a system called the Patient-Driven Groupings Model (PDGM). It's required by law to make sure payments match what's actually happening. Medicare started using this system in 2020, and it also changed how they count services in 30-day periods. This update is about keeping things fair and accurate so that your patients can keep getting the care they need at their homes. In the last two years, CMS made small payment cuts to home health services—3.925% in 2023 and 2.890% in 2024. These changes were only half of what they planned to adjust. It's all part of making sure Medicare payments are just right for the care you need. 

CMS is making some updates to improve how home health care payments work. They're matching up answers from an older survey (OASIS-D) to the new one (OASIS-E) to check for changes in costs. They're also adjusting how they calculate payments for patients with different needs and updating rules for low-use services (LUPA). On top of that, they're using new wage data to make sure payments are fair based on where your patients live. Plus, there are updates for therapy and nursing add-on payments and rules for special outlier cases in 2025. It's all about making things work better for your patients! 

Now, you must know about the major payment and policy updates for home health agencies in 2025. 

Payment and Policy Updates for Home Health Agencies in the upcoming year:  

PGDM and Behavior Assumption:  

CMS has used the PDGM system and a 30-day payment plan to match payments with your patient care needs, especially for complex cases since January 1, 2020. They also make yearly adjustments based on changes in care patterns. This helps ensure fair payments for home health billing service until 2026, keeping care affordable and effective for your patients. 

For 2025, CMS found Medicare is paying more under the new system than the old one. To fix this, they're reducing payments by 1.975%, which is half of the needed 3.95% adjustment. This change helps avoid big cuts later and keeps things fair. CMS will keep reviewing payments until 2026 to make sure everything stays on track. 

Crosswalk for Mapping OASIS-D Data Elements to the Equivalent OASIS-E Data Elements 

The OASIS-D was used for home health assessments under the old 153-group system and the first years of PDGM. In 2023, it switched to OASIS-E. To keep payments accurate, CMS created a plan to match new OASIS-E data with the old system. They also simplified follow-up questions, making things easier for everyone involved. 

Home Health Conditions of Participation (CoPs) Updates 

CMS is making rules to help your patients get the right care faster. Home health agencies (HHAs) must now create a clear policy for accepting patients, review it every year, and follow it for everyone. They'll also share accurate info about their services, so you know what they can provide and any limits. This keeps things fair and simple! 

Home Health (HH) Quality Reporting Program (QRP) Updates 

Starting in 2027, CMS will add new questions about your living situation, food, and utilities, and update a question about transportation. These changes will help them understand your patients' needs better to make sure they get the right care. 

Expanded Home Health Value-Based Purchasing (HHVBP) Model 

CMS is asking for your feedback on new ways to measure home health care in the future. They want to add things like help with bathing and dressing, and even look at how family caregivers are doing. CMS will use patient inputs to make sure home health care gets better for everyone. 

To stay on top of all these changes, a home health billing company can help you keep track of the latest CMS guidelines and policies for 2025. They can make sure your billing is accurate, ensuring you don't miss any updates or payments. With their expertise, you won't have to worry about the complicated rules and adjustments, letting you focus more on providing great care to your patients while staying compliant with all new regulations. So, what are you waiting for? Partner up with home health billing services and enjoy a competitive edge in 2025!