MedPAC Launches Study on Home Health Payment Accuracy
MedPAC is launching a study to assess whether the Patient-Driven Groupings Model (PDGM) accurately matches Medicare home health payments to patient care costs, analysts told commissioners at a Friday meeting. The review will examine home health and skilled nursing facility coding and patient selection practices, including whether high- and low-profit case mix groups are unevenly distributed across providers and whether documentation changes reflect real shifts in patient complexity. Researchers will compare coding patterns for prior-hospitalization cases against SNF and home health coding, and a commissioner flagged concerns that AI tools may already be driving inflated coding intensity. MedPAC, which advises Congress on Medicare, plans to present initial results in fall 2027.