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Understanding Home Health Prospective Payment System (HH PPS) Case-Mix Refinement Changes
[By Staff Reporters]
A few operational changes were made to the V-Code Table in the updated version of the ICD-9-CM Official Guidelines for Coding and Reporting, including:
- HH PPS grouper software and documentation (effective October 1, 2006): Contains Version 1.06 of the home health PPS case mix grouper software codes, which accommodates changes in OASIS reporting requirements effective 10/1/2006. Also includes the grouper coding logic (pseudo-code), test records, and demonstration programs.
- HH Consolidated Billing Master Code List: An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date.
Example:
The national unadjusted (wage index) per-visit rate payments paid per code were: [a] home health aide $44.37; [b] medical social service $153.55; [c] occupational therapy $105.44; [d] skilled nursing care $95.79 and [e] speech pathology $113.81.
Assessment
Link: http://www.cms.hhs.gov/homehealthpps/downloads/transitionepisodesqa.pdf
Link: http://www.cms.hhs.gov/HomeHealthPPS/downloads/GuidanceforHHAs_Posting_12-18-2007.pdf
Conclusion
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Filed under: "Doctors Only", Career Development, CMP Program, Health Insurance, Practice Management, Recommended Books | Tagged: CMS, HH Consolidated Billing Master Code List, HH PPS, HIPPS, Home Health Prospective Payment System, ICD-9-CM, medical billing, OASIS, V-codes |
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Prospective Payment System Proposed for QHCs under the ACA
The support and funding of QHCs is recognized as a key component to success for the ACA and healthcare reform.
On September 23rd, 2013 the Centers for Medicare & Medicaid Services released a proposed rule to clarify the original language in the Patient Protection and Affordable Care Act (ACA) regarding developing a prospective payment system for Federally Qualified Health Centers (QHC).
Under the proposed rule, payments for primary care and preventative services rendered to more than 21 million people at almost 9,000 QHC sites nationwide will receive an estimated 30% increase in payments beginning on October 1st, 2014 and will have to pay no more than 20% in copayments under the ACA.
Click to access QHC.pdf
Robert James Cimasi MSHA AVA CMP™
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Regulatory and Reimbursement Changes Under the FY 2014 IPPS Final Rule
On August 19, 2013, the Centers for Medicare & Medicaid Services released the FY 2014 Medicare Hospital Inpatient Prospective Payment System Final Rule for acute care and long-term care hospitals.
The regulation changes noted in the final rule include new rules allowing re-billing for denied admissions for Medicare Part B, and changes to payment details for the Value Based Purchasing and Hospital Acquired Conditions program.
The regulation that has caused perhaps the most consternation is the “the 2 midnight rule”, requiring that under Medicare Part A, a patient should only be admitted with the expectation that the patient will remain an inpatient for at least two midnights.
Regulatory and Reimbursement Changes Under the FY 2014 IPPS Final Rule
On August 19, 2013, the Centers for Medicare & Medicaid Services released the FY 2014 Medicare Hospital Inpatient Prospective Payment System Final Rule for acute care and long-term care hospitals. The regulation changes noted in the final rule include new rules allowing re-billing for denied admissions for Medicare Part B, and changes to payment details for the Value Based Purchasing and Hospital Acquired Conditions program. The regulation that has caused perhaps the most consternation is the “the 2 midnight rule”, requiring that under Medicare Part A, a patient should only be admitted with the expectation that the patient will remain an inpatient for at least two midnights.
Robert James Cimasi MSHA AVA CMP™
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CMS Issues Final Prospective Payment System for FQHCs
The Center for Medicare & Medicaid Services (CMS) issued the final rule on prospective payment systems for Federally Qualified Health Centers (FQHC) on April 29, 2014. The final rule, serving as the product of a ACA directive to reform previous payment methodologies to FQHCs, creates an encounter-based per diem rate that increases the overall bundled payment made to an FQHC per patient visit.
Click to access FQHCs.pdf
This final rule increases current reimbursement rates by 13%; sets the base rate higher then proposed in 2013 at $158.85; and, establishes a formula for coinsurance. The implementation of the new prospective payment systems is effective October 1, 2014.
Robert James Cimasi MSHA AVA CMP™
http://www.HealthCapital.com
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