CMS reduces payments to home health agencies
The Centers for Medicare & Medicaid Services (CMS) has finalized a 3.79 percent reduction to the home health prospective payment system (PPS) rates for calendar year (CY) 2012 and an additional 1.32 percent reduction for CY 2013, according to its final rule to update the home health PPS for CY 2012.
Published Oct. 31 in the Federal Register, CMS stated payments to home health agencies are estimated to decrease by approximately 2.31 percent or $430 million in CY 2012, the net effect of a 1.4 percent payment update, the wage index update and the case-mix coding adjustment.
CMS also reduced home health PPS rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status, according to a statement from CMS.
This rule also finalized structural changes to the home health PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the home health PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments. “These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients’ health status,” CMS stated.
Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit. The rule also added flexibility to allow physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement, CMS concluded.
Published Oct. 31 in the Federal Register, CMS stated payments to home health agencies are estimated to decrease by approximately 2.31 percent or $430 million in CY 2012, the net effect of a 1.4 percent payment update, the wage index update and the case-mix coding adjustment.
CMS also reduced home health PPS rates in CY 2012 to account for additional growth in aggregate case-mix that is unrelated to changes in patients’ health status, according to a statement from CMS.
This rule also finalized structural changes to the home health PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the home health PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments. “These changes are intended to increase payment accuracy and reduce the growth in aggregate case-mix that is unrelated to changes in patients’ health status,” CMS stated.
Under current Medicare policy, a certifying physician or an allowed non-physician practitioner must see a patient prior to certifying a patient as eligible for the home health benefit. The rule also added flexibility to allow physicians who cared for the patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the requirement, CMS concluded.