Home Health Value-Based Purchasing Program Payment Adjustment Process and Enforcement of Service Codes on Home Health Claims
August 15, 2017 03:39 PM
The Centers for Medicare &Medicaid Services (CMS) has issued Change Request (CR)10167 which provides instructions on how adjustments are to be applied to claims for the home health agencies (HHAs) participating in the Home Health Value Based Purchasing (HHVPB) program.
The HHAs in the nine HHVBP states will have their payments adjusted (upward or downward) in the following manner: a maximum payment adjustment of three percent in CY 2018; a maximum payment adjustment of five percent in CY 2019; a maximum payment adjustment of six percent in CY 2020; a maximum payment adjustment of seven percent in CY 2021; and a maximum payment adjustment of eight percent in CY 2022.
CMS will calculate the standardized home health prospective payment system (HHPPS) amount, including all the HHPPS required adjustments. Once the payment rate for the claim has been calculated, the final claim amount will be multiplying the HHVBP payment adjustment factor. The payment adjustment will only be applied to final claim.
CR 10167 also describes changes to the claim processing system to ensure the required site of service and G-codes for visits are reported with the revenue codes for the service discipline on HHA claims (CR 7182 and CR 9369). Effective January 1, 2018 edits will be activated for HHA claims. Edits to enforce site of service and G-code reporting on hospice claims are currently in place.