Healthcare Provider Solutions

The 2015 Home Care Final Rule has brought about MANY changes in the home care calculations for payment in addition to the Face to Face (F2F) changes that were discussed in last weeks blog. The Home Care Resource Group (HHRG) is the code that results from the point tabulations from responses provided on the OASIS – C1 document following a comprehensive assessment of the patient. Once these points are tabulated they are plugged into the Four Equation Model and the results = HHRG. The HHRG is then converted to a Health Insurance Prospective Payment System (HIPPS) code that is used on the claim to calculate payment for the home care episode. The changes to this system that make a huge difference for 2015 are the changes to the points that are allocated to the questions on the OASIS-C1. Prior to January 1, 2015 there were 19 questions (Mxxxx items) from OASIS-C that effected the calculation. With the changes and implementation of OASIS-C1 we now only have 17. The points for M1200 – Vision and M2030 – Injectable Drugs were both completely stripped from the calculation. In addition, the first 2 Mxxxx items are the Primary and Secondary Diagnoses and several diagnoses were stripped of points for this calculation in 2015.

The following list of diagnosis categories no longer have points associated with the HHRG calculation:

  • Blindness & Low Vision
  • Psychiatric
  • Pulmonary Disorders

The following categories have suffered dramatic point allocation decreases:

  • Diabetes
  • Gastrointestinal Disorders

The following are links to tools that will assist agencies in following the flow of the changes and be able to calculate payment for changes using 2014 data:

2015 PPS Reform Worksheet

http://www.healthcareprovidersolutions.com/Data/Sites/11/skins/art42-bluepatch/downloads/2015_pps_reform_worksheet.pdf

2015 HHRG Spreadsheets

http://www.healthcareprovidersolutions.com/free-downloads

The other change that is quite significant for some is the change to the CBSA codes and corresponding wage indexes. Many counties throughout the country have been changed from a rural status to an urban status in the CBSA classifications for 2015. In addition to being found in the HHRG Spreadsheets on our website, agencies may also reference the changes to the wage index file that was finalized with the Home Care Final Rule 2015. The link is listed below:

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/CMS-1611-F.html?DLPage=1&DLSort=2&DLSortDir=descending

During any year that there are changes in rural vs. urban status, there are also changes to the 5-digit CBSA code used on the claims for that year. If any CBSA area has any new counties added during a transition year then all CBSA codes in that area must use a transitional code for that year.

Example:

Oldham County, TX 99945 in 2014 – – in 2015 it became an urban CBSA area and was moved to 11100. The following counties were already coded to 11100 – Armstrong, Potter, Carson & Randall Counties……due to Oldham being moved into this CBSA area, all counties must utilize a transitional CBSA code for 2015 as follows:

  • Armstrong | 50148
  • Carson | 50148
  • Potter | 50148
  • Randall | 50148
  • Oldham | 50163

Agencies should ensure that claims are all going out with the correct CBSA code or the claims will reject. The transitional codes are only required for one year.