2008 Case-Mix Refinement to the Home Health Prospective Payment System (HH PPS)

HH PPS Refinement Resources

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  • Change Request 6027  Globe to indicate www link. (Written instructions from CMS for system editing to exclude fully denied medically reviewed episodes when determining episode timing)
  • Medicare Learning Network (MLN) Matters Article MM6027 Globe to indicate www link. (Provider instructions from CMS about excluding fully denied episodes by medical review when counting adjacent episodes)
  • Change Request 5877  Globe to indicate www link.  (Written instructions from CMS for system editing of “add-on” amounts applied to Low Utilization Payment Adjustments (LUPAs) on “refined” HH PPS claims)
  • Medicare Learning Network (MLN) Matters Article MM5877 Globe to indicate www link.(Provider instructions from CMS about application of LUPA add-on amounts)
  • Guidance for HHAs  Globe to indicate www link. (Written instructions from CMS for contingency plan options available to HHAs whose billing systems are not ready to implement HH PPS refinement changes on Jan. 1, 2008.)
  • Change Request 5776  Globe to indicate www link. (Written instructions from CMS for system editing of non routine supplies (NRS) on “refined” HH PPS claims)
  • Medicare Learning Network (MLN) Matters Article MM5776 Globe to indicate www link. (Provider instructions from CMS about NRS editing on HH PPS claims)
  • Change Request 5746 Globe to indicate www link. (Written instructions from CMS for submitting claims under the refined PPS requirements)
  • Medicare Learning Network (MLN) Matters Article MM5746 Globe to indicate www link. (Provider instructions from CMS about HH PPS refinement changes)
  • The Proposed Rule Globe to indicate www link. and supporting documentation
  • The Final Rule Globe to indicate www link. and Corrections Globe to indicate www link.
  • Summary Globe to indicate www link. of Final PPS Refinement Changes compared to Current HH PPS Requirements
  • The Home Health & Hospice Medicare A Newslines for updates/additional clarifications on HH PPS refinement

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Other Important HH PPS Links

Page last updated: November 6, 2008

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