Home Health & Hospice Week

The patient’s source of admission would matter under payment revamp.

Under Medicare’s Home Health PPS payment reform plan, the Home Health Groupings Model, home health agencies would see their reimbursement determined by four steps:

Step 1: Classify episodes into four categories based on timing and source of admission — Community Early, Community Late, Institutional Early, Institutional Late.
Step 2: Slot episodes into six clinical groupings (see story, p. 338) based on principal diagnoses reported on the claim.
Step 3: Assign episodes as Low, Medium or High functional levels based on OASIS responses.
Step 4: Adjust for Comorbidities based on secondary diagnoses.

The result: One of 128 HHGM HHRG case mix groupings.

Source: Abt Associates HHGM report released by the Centers for Medicare & Medicaid Services.