Posts tagged ‘icd 9 codes’

August 12, 2010

2011 code thoughts

Go to the Musings of a Code-a-holic page to see my thoughts on the Oct. 1 changes!

July 19, 2010

CMS proposes payment changes to HH services for 2011

CMS is proposing major changes in therapy qualifications, documentation and “effectiveness” of therapy in the 2011 proposed HHPPS rule. It is also proposing case-mix changes and payment changes.

This post gives an overall view and focuses on payment aspects.

The Centers for Medicare & Medicaid Services (CMS) announced late last week in its Home Health Prospective Payment System Rate Update for Calendar Year 2011 Proposed Rule a number of changes for HHAs and Hospice regarding certification, case-mix, therapy and skilled service documentation and requirements, and payment rates.

The proposed rule has a 4.75 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011. Based on updated data analysis, instead of the planned 2.71 percent reduction for CY 2011, CMS proposes to reduce HH PPS rates by 3.79 percent in CY 2011 and an additional 3.79 percent in CY 2012.

The agency estimates that this could be a $900 million decrease compared to payments HHAs received in CY 2010.  The decrease is a combination of market basket update, a wage index update, reductions to the home health prospective payment system (HH PPS) rates and other factors.

The Affordable Care Act (ACA) mandates a 1 percentage reduction to the CY 2011 home health market basket amount. The ACA also changes the existing home health outlier policy through a 5 percent reduction to HH PPS rates, with total outlier payments not to exceed 2.5 percent of the total payments estimated for a given year.

Among the proposals that could help lower payments is a proposal to pull two hypertension codes, 401.9 and 401.1, from the case-mix list. CMS is also proposing far more specific, and restrictive language regarding therapy. The proposals include clarifications on the roles and duties of therapists and assistant, specifics on therapy for rehabilitation or maintenance that moves toward written goals, that all therapy visits must be considered reasonable and necessary, and what constitutes assessment, documentation and goals.

“The new HH PPS provisions will help ensure more accurate payments under Medicare and reflect prudent financial stewardship of the Medicare Trust Fund,” said Jonathan Blum, director of the Center for Medicare and deputy administrator for CMS.

In CY 2010, CMS finalized a policy that requires HHAs that change ownership within three years of initial enrollment to obtain a new State survey or accreditation.  CMS now proposes exceptions to the 36-month provision for certain types of ownership transactions.  CMS is also clarifying the quality reporting requirements for the CY 2012 HH PPS rate update, as it relates to the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey.

Home health payment rates are updated annually by the home health market basket percentage increase.  CMS uses the home health market basket index, which measures (and tracks) inflation in the prices of an appropriate mix of goods and services included in home health services.

Read my post on the HTN case-mix proposal.

Read my post on proposed documentation and therapy roles.

Read about CMS’s specific skilled services wording aimed at reasonable and necessary therapy.

Find out more at www.healthcare.gov.

Read the full proposed rule.

Comments are being accepted until Sept. 14 on this proposed rule, CMS-1510-P. To send comments, go to http://www.regulations.gov.  Follow the instructions under the “More Search Options” tab.

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July 17, 2010

HTN on the case-mix chopping block

A part of the HHPPS payment adjustment for 2011 includes a proposal to remove 401.9, Unspecified Essential Hypertension, and 401.1, Benign Essential Hypertension, from the case-mix list because an analysis shows that patients with these diagnoses don’t use more resources than other patients. This is a huge change, as HTN is an accepted comorbidity that is always coded because it can influence a patient’s health and resource usage.

Read more in the document here, and keep looking on this blog for more news as I review the whole document and post more information.

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May 26, 2010

New Codes Are Officially Out

The 2011 code changes are officially here!

The CDC and NCHS released all of the changes … additions, subtractions, definitions and wording adjustments … earlier today. After a link problem (you couldn’t get to the changes! you can now access changes.

The link incorrectly states that Errata has been posted, but it’s the Addenda for 2011.

Take a peek, and come back here for analysis …

Scroll down to the bottom for the addenda.