Healthcare Provider Solutions

2016 Prospective Payment System (PPS) Rates are just around the corner for home health! These rates will be in effect for episodes ENDING 01/01/16. When the final claim is proposed for payment the new rates will apply.

As has been tradition for many years, HPS has prepared and posted the Updated 2016 HHRG Rate Sheets. In addition to the rates for all 153 Case Mix Weight categories there is a tab, within the spreadsheet, to calculate LUPA rates and LUPA Add-On amounts.

The 2016 Hospice Rates went into effect 10/01/15, but Hospice Payment Reform will go into effect 01/01/16. Hospice Payment Reform includes the staggered Routine Home Care rates and the Service Intensity Add-On (SIA). Also, key to the SIA adjustment, hospices must begin using G0299 (RN) and G0300 (LPN) for all nursing visits 01/01/16 and later. G0154 must be retired effective 12/31/15.

CBSA codes should be a focus of hospice in early 2016. There are many counties throughout the country that had a status change from Rural to Urban, etc. Due to these changes many counties will need to use a Transitional CBSA on HOSPICE claims for 2016. Examples: Pickens County, Alabama was a Rural county with CBSA 99901 and will be Urban with CBSA 46220. The Transitional CBSA code for 2016 will be 5004.

Looking forward to a prosperous New Year in 2016!!