CMS Issues Instructions to Contractors on the 2016 HHPPS Rate Updates
November 13, 2015 09:49 AM
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR)9406/Transmittal 3383 that provides instructions to the Medicare Administrative Contractors (MACs) on the home health prospective payment system (HHPPS) rate update for calendar year 2016.
The transmittal instructs the contractors on the system changes necessary to implement the changes to the Market Basket Update; National, Standardized 60-Day Episode Payment; National Per-Visit Rates; Low-Utilization Payment Adjustment (LUPA); LUPA Add-On Payments; Non-Routine Supply Payments; and Rural Add-on.
Included in the CR are tables outlining the changes made to each of the component parts of the HHPPS and payment amounts associated with the 2 percent reduction for agencies that do not comply with the quality reporting requirements.
In addition, the CR addresses the changes to the International Classification of Diseases (ICD)-10 guidance that permits HHAs to assign “initial encounters” in the 7th character for certain diagnosis codes. Effective January 1, 2016, the HHPPS Grouper logic will be revised to award points for certain initial encounter codes based upon the revised ICD-10-CM coding guidelines for M0090 dates on or after October 1, 2015. Home health agencies should review their Outcome and Assessment Information Set (OASIS) records and claims submitted between October 1, 2015, and December 31, 2015, to determine if they should submit a modification of their assessment and adjust their claim with a revised Health Insurance Prospective Payment System (HIPPS) code.
CMS reiterates that the CY 2016 HHPPS payment rates will be applied to episodes with claim statement “Through” date on or after January 1, 2016, and on or before December 31, 2016.