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Home Health & Hospice Week

Prospective Payment System:

Outlier Cap Will Hurt Diabetic Patients, Cost Medicare Money,Providers Protest

Published on Wed Nov 11, 2009

Watch out: 10% cap could affect your claims as early as next month. Home health agencies are hopping mad about a payment change set to take effect next month, but the feds are standing strong on the 10 percent outlier cap. Multiple home health agencies called into the Dec. 2 Open Door Forum for home care providers to complain about the new policy and ask how to deal with it. Legitimate HHAs are eager to see a crackdown on fraudsters, said a representative from a Miami-area agency. But the new 10 percent cap will be hurting legitimate providers -- and their patients -- as well, he argued. Background: In the 2010 prospective payment system update final rule, the Centers for Medicare & Medicaid Services finalized a 10 percent cap per HHA on outlier payments (see Eli's HCW,Vol. XVIII, No. 39, p. 298). The cap takes aim at fraudulent and abusive billing practices [...]
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