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Is your Home Health Agency ready for PDGM?

Home healthcare PDGMChange is coming. Is your home health agency (HHA) ready? The Centers for Medicare and Medicaid (CMS) recently announced a change coming in 2020 to the payment rate structure for home health agencies. The proposed rule brings other changes as well, changes you and your team need to be ready to implement. Its all part of the Patient-Driven Groupings Model (PDGM) that CMS says will drive better patient care based on patient needs and not the volume of care. In this article we’ll summarize the proposed changes. We’ll also offer up a short suggested to do list for any home health agency wondering where to start.

First, a look at some of the key changes for HHAs that take effect in January of 2020:

-Change the way episodic payments to home health agencies are made from a 60-day time frame to 30 days.

-Change in-home infusion therapy payment rates: temporary transitional payment rates for 2020, new permanent home infusion therapy rates to take effect in calendar year 2021.

-Home infusion therapy proposed payment changes:

                -Three payment categories for home infusion drugs

                -Payment rates to factor in geographic location (Geographic Adjustment Factor (GAF))

   -Higher payments for first home infusion therapy visit, small decrease in payment for each   visit after that

-Phase out Requests for Anticipated Payment (RAP) in an attempt to curb any potential program integrity possibilities.

-In an effort to improve access to care, allow therapy assistants to provide maintenance therapy. The change would be consistent with regulations for skilled nursing facilities.

-Adopt new quality measures to evaluate the effective transfer of home health information with the goal of improved patient safety and accurate medication lists.

-Adopt new patient assessment data including:

  • Cognitive function
  • Mental status
  • Special services
  • Treatments and interventions
  • Medical conditions and comorbidities
  • Social determinants of health

-Remove pain-related quality measures in an attempt to avoid over-prescription of opioids.

-Public report of Total Performance Scores (TPS) for home health agencies which could lead to better, more objective comparisons of caregivers and incentives for improved performance of HHAs.

“Most larger home health organizations are likely already well on their way to compliance ahead of the January 2020 adoption of the proposed rule,” says Gilmore Jasion Mahler Healthcare Specialist Jamie Dixon, CPA. “I’m already talking with my clients about this, they know it’s happening and are already preparing. It’s the smaller home health agencies with fewer resources that I am worried about.”

Jamie’s worked in the healthcare space for many years. A member of the Gilmore Jasion Mahler Healthcare Specialist Team, his focus areas include home health, hospice and skilled nursing. His experience includes Medicaid and Medicare reimbursement consulting, cost report preparation and review as well as specialized accounting issues related to healthcare entities.

He suggests three priorities for any HHA that doesn’t know where to start in preparing for the new regulations.

  1. Talk to your vendors. Make sure they’re aware of the changes.
  2. Make sure your billers are trained on the new system.
  3. Rely on trusted resources to learn more.

“In my mind, #3 is especially important,” says Dixon. “Your agency’s accounting firm should definitely be one of those trusted resources. I’m having a lot of conversations right now with my home health clients. Sometimes they just need to run something by me to get my take. Other times I’m more involved in driving decisions. This is a big change that involves some serious planning. Now is the time to prepare, so that when year-end comes, you’re ready for PDGM.”

You can learn more about the home health Patient-Driven Groupings Model (PDGM) on the CMS website where you’ll find several resources for home health agencies.

Established in 1996, Gilmore Jasion Mahler, LTD (GJM) is the largest public accounting firm in Northwest Ohio, with offices in Maumee and Findlay. Locally owned, GJM offers cloud-based accounting and provides comprehensive services including assurance, business advisory, tax, risk advisory, healthcare management and outsourced accounting. The Firm’s professionals specialize in industries including construction & real estate, healthcare, manufacturing & distribution and utilities.  

Get More Out of Your Health Savings Account

Health Savings AccountMillions of Americans use a health savings account, or HSA, to save for medical costs. But, are you getting the most out of your HSA? Gilmore Jasion Mahler CPA Charlie Heid recently tackled the topic in his monthly appearance on WTOL-TV.

The HSA or health savings account is a way to save money for medical expenses for people who have health coverage through a high deductible health plan.

You can pay for things like:

  • Doctor’s visits & copays
  • Surgery
  • Dental work
  • Flu shots

Unlike a flexible spending account, or FSA, which some people may get confused with an HSA, the HSA balance rolls over from year to year, and if you change jobs you can take your HSA with you.

Health savings accounts are referred to as a triple-tax free way to save… and here’s what that means:

  1. Your money goes into the account before its taxed
  2. It grows in the account tax deferred
  3. You can withdraw the money tax-free to pay for medical expenses

But there’s another benefit of the HSA that many people may not be aware of: when you turn 65 the HSA works like a traditional IRA. At 65 and older you can take money out and use it for whatever you want (not just medical expenses), though you would have to pay taxes on it when you do. But, you can still use that money tax-free for medical expenses in retirement.

There are some limits to what you can put into an HSA on an annual basis. They’ve actually gone up a bit in 2019 from 2018. A single person can put in up to $3,500 a year and a family can put in up to $7,000 per year.

If you’re 55 or older you can put in an extra $1,000 as a so-called catch-up contribution. That’s to help people who are nearing retirement age who feel they haven’t saved enough.

HSAs can be a powerful tool in saving for retirement. They can actually be invested in mutual funds to grow even further. If you do automatic payroll deduction for your HSA, unlike your 401(k) or IRA, that money isn’t subject to a federal income tax known as FICA, or the Federal Insurance Contributions Act, which goes toward Social Security and Medicare.

If you invest your HSA balance, be aware that some organizations can charge pretty big fees and some also have a required minimum balance before you’re allowed to invest.  

Some other things to keep in mind:

  • If you do invest your HSA, be sure to consult an expert so that you invest wisely
  • You can change the amount of your HSA contribution whenever you want, as long as you don’t go over the annual contribution limit
  • You need to keep receipts so that, if need be, you can prove that the medical expenses meet IRS requirements
  • Finally, other people can contribute to your health savings account. You can contribute separately from your payroll deduction. Your employer, family members or anyone else can also contribute as long as you stay below the annual contribution limit

CPA Charlie Heid is a partner specializing in tax services. He has been with Gilmore Jasion Mahler for 17 years and appears monthly on WTOL 11 Your Day to cover tax and money topics.

Established in 1996, Gilmore Jasion Mahler, LTD (GJM) is the largest public accounting firm in Northwest Ohio, with offices in Maumee and Findlay. Locally owned, GJM offers cloud-based accounting and provides comprehensive services including assurance, business advisory, tax, risk advisory, healthcare management and outsourced accounting. The Firm’s professionals specialize in industries including construction & real estate, healthcare, manufacturing & distribution and utilities.  

Business Valuation: What to Look for in an Expert

You know you need a business valuation, but who should do it and how in depth should it be? Gilmore Jasion Mahler Partner Jeff Denning specializes in business valuation and says be aware that the IRS or a court of law will have some requirements when it comes to the valuation, and who does the work. He offers some ideas on how to go about choosing the right person for the job.

Who does a valuation for your business is one of several important questions as you begin to research the process. For more information, see GJM's video blogs How Do You Figure Out the Value of Your Business, Business Valuation: Lengthy Report or Not, and What is the Business Valuation Process. Learn more about Jeff’s expertise in business valuation and forensic accounting, and don’t forget to sign up for GJM’s free quarterly newsletter The Expert with a focus on business valuation and litigation support. Just click here for quick and easy sign up.

Established in 1996, Gilmore Jasion Mahler, LTD (GJM) is the largest public accounting firm in Northwest Ohio, with offices in Maumee and Findlay. Locally owned, GJM offers cloud-based accounting services and provides comprehensive services including assurance, business advisory, tax, risk advisory, healthcare management and outsourced accounting. The Firm’s professionals specialize in industries including construction & real estate, healthcare, manufacturing & distribution and utilities

Business Valuation: In Depth Report or Not?

Do you need to figure out what your business is worth? If you’re looking into getting a business valuation, you have some decisions to make. Gilmore Jasion Mahler (GJM) Partner Jeff Denning specializes in business valuation and says you could pursue a detailed (possibly 100 page) report, or a less detailed report. Which one do you need? Jeff has some answers in our most recent video blog.

Learn more about Jeff’s expertise in business valuation and GJM's forensic services, and don’t forget to sign up for our free quarterly newsletter The Expert. It offers timely and helpful articles with a focus on business valuation and litigation support. Just click here for quick and easy sign up.

Established in 1996, Gilmore Jasion Mahler, LTD (GJM) is the largest public accounting firm in Northwest Ohio, with offices in Maumee and Findlay. Locally owned, GJM offers cloud-based accounting services and provides comprehensive services including assurance, business advisory, tax, risk advisory, healthcare management and outsourced accounting. The Firm's professionals specialize in industries including construction & real estate, healthcare, manufacturing & distribution and utilities

Is it Time to Outsource Your Business Accounting?

Running a business isn’t for sissies. You bring in good people to manage the office, handle human resources and oversee the financials for you, but in the end, you know you’re ultimately responsible.

Did you double check that last invoice that went out to your best customer? What’s the balance on your business loan? How much cash is available right now? 

What if you could stop fretting over questions like that and know someone’s got your back around the clock? That’s the basic concept behind Gilmore Jasion Mahler’s Outsourced Accounting Services. We’ll call it the best of both worlds: a team of specialists is on the job, and you get to see the numbers anytime you want right on your cell phone.

Your team is there to answer questions, advise you on business decisions, if desired, and yes, to handle the books.

Advances in technology are changing the way many businesses handle the business manager role at the office. That includes many healthcare entities, including physician and dental practices. Many are embracing the technology, letting a specialized team handle the work, and turning their attention to growth strategy and other priorities. Outsourced accounting can also be an excellent fit for nonprofit organizations struggling to fill positions with knowledgeable, capable individuals.

Picture this: real time financial key performance indicators you can see any time of the day or night on your cell phone or other device. More importantly, a team of professionals working with you who not only look at today’s numbers, but help you plan and strategize for the future.

Some key benefits to outsourced accounting with Gilmore Jasion Mahler:

  1. Stop struggling to fill that internal business manager role (seems like there’s always an opening, doesn’t it?).
  2. Real time data at your fingertips around the clock whether you’re in the office or the sidelines of your daughter’s soccer game.
  3. A team consisting of accounting specialists, including a GJM partner, to handle the business finances and also guide and advise on other important financial decisions as needed.
  4. Dashboard view of your financials via leading edge accounting software platform Sage/Intacct.

Interested in learning more about Gilmore Jasion Mahler’s Outsourced Accounting Services? Read up on our team's capabilities. You can also contact our Accounting Specialist Team to start the conversation.

Gilmore Jasion Mahler’s Judy Anderson, CPA contributed this blog. Judy leads the GJM Outsourced Accounting Specialist Team. With over 20 years of experience in public accounting and private industry, Judy works with clients across a number of industries, including healthcare, nonprofit, and professional services.

Established in 1996, Gilmore Jasion Mahler, LTD (GJM) is the largest public accounting firm in Northwest Ohio, with offices in Maumee and Findlay. Locally owned, GJM offers comprehensive services including assurance, business advisory, tax, risk advisory, healthcare management and outsourced accounting. The Firm’s professionals specialize in industries including construction & real estate, healthcare, manufacturing & distribution and utilities.