CMS Proposes Home Health Medicare Payment Changes: 4 Things to Know

CMS has released proposed changes to the Medicare home health prospective payment system for calendar year 2015.

Here are four things to know from the CMS announcement and fact sheet.

1. According to the most recent CMS data, roughly 3.5 million beneficiaries received home health services in 2013 from 12,000 home health agencies, accounting for approximately $18 billion in Medicare spending.

2. Overall, CMS expects that its proposed changes — which include calibrating case-mix weights relative to each other, based on 2013 data, and alterations to the wage index related to Metropolitan Statistical Area delineation changes — to the payment system for 2015 will reduce Medicare payments to home health agencies by 0.3 percent, or $58 million.

3. The proposed 0.3 percent decrease takes into account a 2.2 percent home health payment update percentage and rebasing adjustments to the national, standardized 60-day episode payment rate, national per-visit payment rates and the non-routine medical supplies conversion factor.

4. The PPACA mandates that certifying physicians or allowed non-physician providers must have a face-to-face encounter with a patient before certifying eligibility for the Medicare home health benefit. Among other changes in the proposed rule, CMS has proposed eliminating the face-to-face encounter narrative requirement, under which providers must write a brief description of the patient's clinical condition and how that condition supports homebound status and the need for skilled services. Under the CMS proposed rule, the physician would still need to certify that a face-to-face encounter occurred and document the date of the encounter.  

For more information, view the full proposed rule here. CMS will accept comments on the rule until Sept. 2.

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