Home Health & Hospice Week

RHHI tells agencies how to ID their PPS adjustments. A correction for a nagging PPS claims problem is coming, but not anytime soon -- leaving you vulnerable to incorrect payments in the meantime. The Centers for Medicare & Medicaid Services will change the claims system to fix episode sequencing errors for episodes with 20 or more therapy visits, according to Jan. 30 CR 6305 (Transmittal No. 434). Under current PPS Pricer software, an episode is assigned to Payment Grouping 5 if it has 20 or more therapy visits, so the five-digit HIPPS code would start with a 5. "The initial requirements for HH PPS case-mix refinements excluded HIPPS codes beginning with 5 from the edits that enforce correct episode sequence," CMS explains in the transmittal. The problem: That's fine if the episode is expected to be in the 20-therapy-visit Group 5 category the whole time, CMS says. But if the claim must [...]