Prospective Payment System

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Submitted By marled
Words 671
Pages 3
When it comes to prospective payment systems in the medical field, on acronym we see is HHRG. HHRG stands for home health resource group. A temporary home health payment systems for Medicare was implemented in 1999 with the final PPS taking place in the fall of 2000. Home health care agencies provide patients who are homebound with services such as physical/occupational/speech therapy, social work, or skilled nursing care in the comfort of their home.
Under this PPS, Medicare would reimburse home health agencies a predetermined flat rate. This rate does have a few things that are considered when determining what the base amount will be. When determining the level of care that is needed health condition and care needed for the patient or beneficiary and geographical factors such as wage are all considered. This list of considerations is called a case-mix adjustment. Case-mix adjustment is one of the 6 main features of the home health prospective payment system. Another major point of the home health PPS with Medicare is the 60 day episode rule. The agency receives half of the cost at the start of the 60 days when the initial claim is filed. When the 60 days comes to a close and the final claim is sent in they will receive the remainder of the payment for services. In the case that a patient needs care past the 60 days, a new 60 day episode claim must be started. There are a few incidences that can call for adjustments in the reimbursement amount. First is a patient who needs only a few visits of care within a 60 day episode period. If the beneficiary needs 4 days or less of care, adjustments will be made for payment to be in a per visit amount. A patient could be discharged and readmitted within a 60 day episode. If this happens then each new admit is billed as a 60 day episode. If the first episode was discharged after 30 days then the payments made will be…...

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