The Centers for Medicare and Medicaid Services CMS released its final 2012 HHPPS regulation October 31, 2011. According to IHHC, “The 2012 National Episode Rate will be a little higher than was proposed because CMS has decided to phase in the proposed 2012 case-mix creep reduction over two years. As a result, the case mix creep reduction for 2012 will be 3.79% with a 2013 reduction of 1.32%. With the market basket increase and other planned adjustments, the 2012 National Episode Rate will be $2,138.52, 2.4% than the 2011 rate of $2,192.07. Agencies that have failed to submit OASIS data and/or HHCAHPS data will experience a 2 percentage point decrease in the market basket increase of 1.4%.”
CMS has adjusted its proposed reallocation of points from therapy to non-therapy episodes. According to Home Health Line, episodes with zero to five therapy visits will see a 3.75% increase, compared with the proposed 7.5%. Episodes with 14 or 15 visits will see a 2.5% reduction, compared with a 5% proposed reduction. And, episodes with 20 or more visits will see a 5% reduction, compared with the proposed 10%. Still, providers with a high percentage of therapy cases will see the most significant reductions in reimbursement in 2012.
CMS is also proceeding with its plan to reallocate point away from two hypertension codes: 401.1 (benign essential hypertension) and 401.9 (unspecified essential hypertension).
Finally, the proposed change in the face-to-face requirements to allow institutional physicians to hold the encounter and then report findings to the community physician who then certifies the patient for home health services has been adopted. “Click here for detail on the rules”
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