Posts tagged ‘HHPPS’

December 5, 2011

OASIS Tour is up and running

It’s not too late to sign up for my OASIS: Strategies for Success seminars!

We’re touring in:

Dec. 5-6: Houston

Dec. 13-14: Dallas

Dec.15-16: McAllen

This is beyond basics. Here are some highlights of what we will focus on:


  • What OASIS is used for, and why accurate and consistent assessment really matters
  • How to score OASIS items on a Start of Care assessment
  • Techniques to improve assessment accuracy and speed
  • How responses to individual OASIS items impact your agency’s reimbursement, OBQI outcome scores, and OBQM avoidable events
  • How the new risk adjustment model works, and how your clinicians’ OASIS responses shape your agency’s case mix profile and outcomes
  • How to put all the pieces together to improve care delivery and quality outcomes

Learn more and register!

November 14, 2011

Jan. 1 M0090 date is the end for case-mix hypertension

CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.

“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”

Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.

Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.

However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).

Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!

Grouper information!

July 5, 2011

Hypertension gets tha axe in proposed rule

The calendar year 2012 home health proposed rule is proposing a few changes that could greatly affect payment to HHAs:

  • 401.1 and 401.9 may be removed from the case-mix list. CMS has done a series of analyses on use of the codes and resource use. The agency proposes removing these to more accurately align resources and payment use.
  • Lowering payments on high therapy episodes
  • Adjusting case-mix weights

More to come soon …

July 5, 2011

Payments will decrease if 2012 proposed rule goes into effect

A proposed rule in the Federal Register on Tuesday proposes a 3.35 percent decrease in Medicare payments to HHAs for calendar year 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011.  It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the HHPPS rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to  changes in the health status of patients (a $950 million decrease). 

Provisions of the Affordable Care Act (ACA) mandate that CMS apply a one (1) percentage point reduction to the CY 2012 home health market basket amount; this would equate to a proposed 1.5 percent update for HHAs next year.  As part of the HH PPS rate update, CMS also proposes to reduce HH PPS rates by 5.06 percent in CY 2012 to account for the increase in the case-mix that is unrelated to changes in patient acuity.

The Medicare HHA proposed rule would also make structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same amount of total aggregate payments.      

The proposed home health market basket increase for CY 2012 is 1.5 percent.  HHAs that submit the required quality data would receive payments based on this full home health market basket update.  If an HHA does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points to -0.5 percent for CY 2012.

See the proposed rule.


April 26, 2011

Major improvement or decline require a follow-up assessment

Question: Let’s say that I did a recert on 4/11/2011 and then the patient had an outpatient mastectomy 4/12/2011.  I went to see her on 4/13/2011, which was the first day of her recert. Would this visit be considered a SCIC or can we do as a regular visit and a telephone order for the orders of the mastectomy care?

Lisa says: A follow-up assessment is required for a major improvement or decline in condition, but your policy defines  major improvement or decline. You must complete another follow-up assessment if the circumstances meet your policy.