Home Health & Hospice Week

Get Ready For These PPS Adjustments

Get the details on corrections to these nine prospective payment system refinements errors in 2008 that will soon be coming your way (see related story, p. 314).

Error #1) The supply add-on amount was paid on episodes that began in 2007 and spanned Jan. 1, 2008. The supply add-on is properly only applicable for episodes beginning on or after Jan. 1. This error resulted in overpayments of the minimum supply add-on amount of $14.12.

Error #2) Appropriate upcoding of claims containing exactly 20 therapy visits but which reported a HIPPS code projecting a lower number of therapy visits did not occur.

Error #3) Low utilization payment adjustment (LUPA) add-on payments failed to wage adjust.

Error #4) The full non-routine supply add-on amount was paid on claims for episodes subject to partial episode payment (PEP) adjustment. The supply add-on should have been prorated.

Error #5) The LUPA add-on amount was paid on all home health visit lines on a LUPA episode claim. The LUPA add-on should properly only be paid on the earliest dated home health visit line on a claim. Claims had four or fewer visits and were the first episodes in a sequence of related episodes.

Error #6) Episodes that occurred in 2007 weren't recognized when determining episode sequences. This caused claims for later episodes to be recoded and paid as early episodes in error.

Error #7) An incorrect per-visit rate for speech-language pathology (SLP) services was paid. The SLP rate of $124.54, as published in the original HH PPS final rule, was paid rather than the corrected amount of $124.65, as published in the correction notice to that rule.

Error #8) An error in recoding logic prevented the clinical domain value of the HIPPS code from being changed appropriately in certain cases. If the grouping step for the episode changed to step two during processing and the corresponding clinical severity value in the treatment authorization code was "G" or "N," the clinical domain value in the HIPPS code was assigned to an incorrectly low weight. This error resulted in underpayments.

Error #9) Claims were incorrectly paid using the 2007 wage index instead of the 2008 one. Source: Oct. 31 CR 6250 (Transmittal No. 397) online at http://www.cms.hhs.gov/transmittals/downloads/R397OTN.pdf.