Medicare Compliance & Reimbursement

PPS tune-up will likely include big changes for therapists.

The first overhaul of the prospective payment system is slated to take effect in a year and a half, and therapists working in home health agencies could see some significant changes.
 
In the Department of Health and Human Services' latest semiannual regulatory agenda, the Centers for Medicare and Medicaid Services says this December it will issue a proposed rule containing major PPS changes.   "This rule proposes the first major refinements to the payment system since its implementation in October of 2000," CMS says in the agenda published in the May 16 Federal Register.
 
While the proposed rule will come out in December 2005, the changes wouldn't take effect until January 2007, CMS notes.
 
A CMS official outlined possible changes at the National Association for Home Care & Hospice's April policy conference in Washington, DC, according to NAHC's Mary St. Pierre. Case-Mix Categories Up For Revision Expected revisions include refining the case-mix categories, changing the therapy threshold, addressing medical supplies and adjusting reimbursement for subsequent episodes, St. Pierre reports.
 
CMS might change the therapy threshold quite dramatically to take into account patient characteristics rather than the number of therapy visits, St. Pierre adds.