Posts Tagged ‘Home Health PPS’

Fazzi Associates: New National Average Case Mix Weight

August 1, 2013

Question: We saw the Minute in the Morning email with a preliminary case mix weight of 1.3517, up from 1.27.  Can you tell me more about it and what that means for my agency? (more…)

Industry Reps Meet with Key Congressman to Discuss CMS Proposed Rule

July 12, 2013

FL-USCong_Bilirakis-2013-07-12Home care industry representatives today met with U.S. Representative Gus Bilirakis (R-Tarpon Springs), a four-term Tampa Bay area congressman who serves on a key health care committee in Congress.

BAYADA Home Health Care’s Jeanne Barton and Carson Barnes and HCAF’s Kyle Simon met with Rep. Bilirakis to discuss the recent CMS proposed rule, which calls for a 1.5 percent cut Medicare home health reimbursement rates in 2014. The rule also includes a 3.5 percent annual cut over four years to rebase Medicare rates, as required by the Affordable Care Act. The discussion gave industry representatives the opportunity to highlight to Rep. Bilirakis the importance of home health care and the role it plays in offering high quality, cost effective care for more than 300,000 Florida seniors each year.


Home Health Firms Met With OMB, But Failed To Avert Proposed Pay Cuts

July 11, 2013

By John Wilkerson, Inside Washington Publishers

Representatives of the home health industry met with Office of Management and Budget officials to make a case against pay cuts shortly before CMS proposed the 2014 pay rule for that sector, but the proposed rule that industry had been awaiting since the Affordable Care Act passed still made pay cuts that the Partnership for Quality Home Healthcare called “alarming.” Industry is arguing for more targeted pay cuts and is lobbying for an alternative fraud-fighting proposal that it estimates would save nearly $20 billion – industry’s earlier preliminary estimates put the savings at around $15 billion.

The Partnership for Quality Home Healthcare on July 10 issued results of a national poll of registered voters that finds that 93 percent of seniors surveyed think Congress should stop Medicare fraud instead of cutting Medicare payments or increasing fees on seniors’ Medicare services. (more…)

Palmetto GBA: Medical Review Requirements for HH Face-to-Face Documentation

May 22, 2013

Palmetto GBA has noticed an increase in overpayments for Home Health Prospective Payment System (HH PPS) claims. The top reason for this increase is attributed to the requirement for a face-to-face encounter with the beneficiary.

Palmetto GBA evaluated its criteria for review of these types of claims. Effective immediately, Palmetto will begin a more comprehensive review using the regulations governing these types of claims. Palmetto GBA encourages all providers to review their internal processes to ensure that all of the criteria for coverage have been met and documented in the medical record. (more…)

Palmetto GBA Update on Data Reporting on HH PPS Claims

April 8, 2013

Palmetto GBA announced this week Change Request 8136, which adds new data reporting requirements for Home Health Prospective Payment System (HH PPS) claims. Home health agencies must report new codes indicating the location of where services were provided and indicating whether services were added to the HH plan of care by a physician who did not certify the plan of care. Make sure that your billing staffs are aware of these changes.


Generally, Original Medicare makes payment under the HH PPS on the basis of a national standardized 60-day episode payment rate that is adjusted for the applicable case-mix and wage index. The national standardized 60-day episode rate pays for the delivery of home health services, which includes the six home health disciplines (skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy and medical social services). Claims must report all home health services provided to the beneficiary within the episode. (more…)

CMS to Host Home Health Open Door Forum on Jan. 9th

January 2, 2013

The Centers for Medicare & Medicaid Services’ Home Health, Hospice & Durable Medical Equipment Open Door Forum is scheduled for next Wednesday, January 9, 2013, from 2:00-3:00pm ET.

The Forum addresses the concerns of three unique health care areas within the Medicare and Medicaid programs. Issues related to Home Health PPS, the newly proposed competitive bidding for DME, and the Medicare Hospice benefit are all topics the forum has covered. Many of the issues covered bridge concerns within all three settings, and the combination of the topics under one Forum has been useful to many participants. Timely announcements and clarifications regarding important rulemaking, agency program initiatives, and other related areas are also included in the forums. (more…)