CMS Announces 2015 Medicare Payment Changes For Home Health Agencies

CMS has announced changes to the Medicare home health prospective payment system (HH PPS) for CY 2015 to increase efficiency, flexibility, payment accuracy, and improved quality.

CMS projects that Medicare payments to home health agencies in CY 2015 will be reduced by 0.30 percent, or $60 million. This decrease reflects the effect of the 2.1 percent home health payment update percentage ($390 million increase) and the second year of the four-year phase-in of the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor (2.4 percent or $450 million decrease).

Notable changes:

  • CMS is eliminating the physician narrative requirement for F2F.
  • CMS will require physicians to have sufficient documentation in their own files to support the certification of homebound status and skilled care need. CMS will allow agencies to provide their record to the certifying physician so it can be included in considering if sufficient documentation exists to support the certification. CMS has also modified the rule to require that certifying physicians submit their records to agencies whenever a claim is audited for compliance.
  • Rate rebasing will continue with an $80.95 base episode reduction offset by a 2.1% inflation update (2.6 MI minus 0.5 productivity adjustment) along with the second year adjustments to LUPA and NRS rates. The productivity adjustment is 0.1% greater than proposed leading to a slightly lower inflation update.

Click here to view the final rule. This link will change once it is published in the Federal Register on November 6, 2014.

Click here for additional information about the Home Health Prospective Payment System.

VA To Pay Non-Contract Providers Using Medicare Payment Models

According to NAHC, the Department of Veterans Affairs (VA) has started issuing notices to inform home health providers of the VA’s revised payment methodology for SNF services. Starting on October 1, 2014, the VA will require an Outcome and Assessment Information Set (OASIS) to be completed to generate a health insurance prospective payment system (HIPPS) code to reimburse non-contracted home health agencies for skilled home health services using the Medicare home health prospective payment system (HHPPS). The VA will continue to pay a per diem rate for non-contracted hospice providers.

Click here to read more from NAHC.

CMS: Modifier No Longer Needed For Plan Of Care Changes

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released CR8136 which adds new data reporting requirements for Home Health Prospective Payment System (HH PPS) claims. Per the transmittal, home health agencies (HHAs) will no longer be required to apply a modifier to changes/additions to the plan of care by a physician other than the certifying physician for episodes starting on or after July 1.

Click here to read more.