CMS Billing Clarification

Last week, CMS issued the CY 2017 Medicare Home Health Prospective Payment System Final Rule.

Overall, CMS estimates a 0.7% reduction in Medicare home health payments ($130 million in 2017 nationally.)

Here are the ingredients:

  • A market basket update of 2.5%  (a $450 million increase)
  • A 0.97% reduction in the national, episodic base rate due to “nominal” case-mix growth (a $160 million decrease)
  • A rebasing adjustment to the national episodic payment, per-visit rate and non-routine medical supplies conversion factor –the final year of the 4-year rebasing phase-in ( a $420 million decrease)

Wage Index Adjustments

  • Rural NH, CY 2017 – 1.0212, an increase over the 2016 wage index of 1.0041
  • Urban, CBSA 31700 – Hillsborough,  CY 2017 – 0.9865, a decrease from the 2016 wage index of 1.0074
  • Urban, CBSA 40484 – Rockingham/Strafford, CY 2017 – 0.9865, a decrease from the 2016 wage index of 0.9946

Payment Changes for Negative Wound Pressure Therapy Using a Disposable Device

  • This is complicated.  The Home Care Association of NY State did an excellent overview of the payment changes.  See attachment.


Other Components of the Rule

  • Significant changes to the outlier payment methodology
  • CMS’s plans to group HHPPS claims centrally during claims processing
  • Updates to the HHVBP Pilot Program
  • Updates to the Home Health Quality Reporting Program
  • Submission requirements of the OASIS to avoid a payment rate reduction in 2017


HCANH will provide you with more detailed analyses from the national associations when it’s are available.


Other resources:

, , , ,