Home Health & Hospice Week

Bad news: Rural add-on is not renewed.

Medicare's drastic payment revamp may be off the table for 2019, but the 0.4 percent payment decrease proposed for 2018 will unfortunately stay intact.

So says the 2018 Home Health Prospective Payment System final rule posted by the Centers for Medicare & Medicaid Services late Nov. 1, which finalizes the cut expected to reduce Medicare's home health spending by $80 million next year.

The rule contains another "sad note," says finance expert Tom Boyd, VP of Reimbursable Services with Simione Healthcare Consultants in Rohnert Park, California - "the loss of the rural add on, which will hurt the population with the greatest need for better and proper HHA payments."

This 0.4 percent decrease reflects the effects of a 1 percent home health payment update percentage ($190 million increase); a -0.97 percent adjustment to the national, standardized 60-day episode payment

rate to account for nominal case-mix growth for an impact of -0.9 percent ($170 million decrease); and the sunset of the rural add-on provision for an impact of -0.5 percent ($100 million decrease), CMS explains on its website.

Remember: The combination of wage index changes, the base rate, and case mix changes affected by your patient mix will determine whether you'll see gains or losses over this year's rates in 2018, advises Dave Macke, Director of Reimbursement Services with VonLehman & Co. in Ft. Wright, Kentucky.

Beware: Twenty CBSAs see wage index drops of more than 5 percent in the final rule, Macke warns.