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Home Health & Hospice Week

Prospective Payment System:

HOW TO CALCULATE YOUR PPS PAYMENTS

Published on Tue Apr 17, 2007

Chart helps you compare the old and new ways Medicare will reimburse you.

Life is about to get a lot more complicated, if the prospective payment system refinements become final.

The Centers for Medicare & Medicaid Services proposed sweeping changes to PPS in a regulation issued April 27 (see Eli's HCW, Vol. XVI, No. 16). The refinements include a multi-tier therapy threshold and increase from 80 to 153 HHRGs.

"The new rule certainly does not make it easier to determine the correct payment," notes Abilene, TX-based consultant Bobby Dusek.

There is no simple, straightforward way to calculate reimbursement levels under the proposed rule, says consultant Lynda Laff with Laff Associates in Hilton Head, SC. "Every time I think I've got it down to 'simple,' I find that I have forgotten something," Laff quips.

Take a look in this chart at the main steps to calculate PPS payment, as reviewed by industry experts:

For an example of how you calculate payment once you have determined the HHRG (steps 5 and 6 in the chart), see the box, next page.

Note: To order a transcript or recording of Mark Sharp's May 17 Eli-sponsored audioconference about the proposed PPS refinements, go to http://goto.elinetwork.net/go/6766 .

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